Provider Demographics
NPI:1801987185
Name:GANDHI, ANIL KUMAR (MD)
Entity type:Individual
Prefix:
First Name:ANIL
Middle Name:KUMAR
Last Name:GANDHI
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 1:71 WEST 156TH STREET
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HARVEY
Mailing Address - State:IL
Mailing Address - Zip Code:60426-4262
Mailing Address - Country:US
Mailing Address - Phone:708-339-8833
Mailing Address - Fax:708-333-4229
Practice Address - Street 1:71 WEST 156TH STREET
Practice Address - Street 2:SUITE 206
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-4262
Practice Address - Country:US
Practice Address - Phone:708-339-8833
Practice Address - Fax:708-333-4229
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL695220Medicare ID - Type Unspecified
C67393Medicare UPIN