MEDICARE: HETAL N. GANDHI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0101240240	VA
2	207Q00000X	Family Medicine Physician	01061939A	IN
3	207Q00000X	Family Medicine Physician	N5064	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1231121	OTHER		CHA
2	7809815	OTHER		AETNA
3	TN-0107	OTHER		JOHN DEERE HEALTH
4	238422	OTHER	VA	ANTHEM BLUE SHIELD
5	C09011	OTHER	VA	TRAILBLAZER GROUP NUMBER
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	N5064	OTHER	TX	TEXAS MEDICAL BOARD
8	011402D11	OTHER	VA	TRAILBLAZER

General Provider Information

NPI Number	:	1013936905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HETAL N. GANDHI MD

Provider Business Mailing Address
First Line	:	7077 HIGHWAY 6 N
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-2505
Country	:	US
Telephone Number	:	832-937-5905
Fax Number	:

Provider Business Practice Location Address
First Line	:	7077 HIGHWAY 6 N
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-2505
Country	:	US
Telephone Number	:	832-937-5905
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	10/21/2022

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Directions to “ HETAL N. GANDHI MD” Practice Location

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