Provider Demographics
NPI:1790126753
Name:GANDAPUR, YOUSUF KHAN (MD)
Entity type:Individual
Prefix:
First Name:YOUSUF
Middle Name:KHAN
Last Name:GANDAPUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1447 MEDICAL PARK BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-3164
Mailing Address - Country:US
Mailing Address - Phone:561-753-0001
Mailing Address - Fax:561-753-0005
Practice Address - Street 1:1447 MEDICAL PARK BLVD STE 101
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-3164
Practice Address - Country:US
Practice Address - Phone:561-753-0001
Practice Address - Fax:561-753-0005
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD81297207R00000X
NY311536207RC0000X
390200000X
FLME169735207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program