Healthcare Provider Details

I. General information

NPI: 1497318950
Provider Name (Legal Business Name): KHUSHABU GANDHI NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2019
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 SPRINGFIELD DR STE 210
BLOOMINGDALE IL
60108-2215
US

IV. Provider business mailing address

POB 7132960
CHICAGO IL
60677-0001
US

V. Phone/Fax

Practice location:
  • Phone: 630-893-2210
  • Fax: 630-307-0482
Mailing address:
  • Phone: 630-469-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209-019157
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101920
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209-019157
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041463911
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: