Healthcare Provider Details

I. General information

NPI: 1003181728
Provider Name (Legal Business Name): HARIVADAN K GANDHI MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7845 S COTTAGE GROVE AVE SUITE#101
CHICAGO IL
60619-3100
US

IV. Provider business mailing address

143 SILO RIDGE RD N
ORLAND PARK IL
60467-7315
US

V. Phone/Fax

Practice location:
  • Phone: 773-488-7744
  • Fax: 773-488-3669
Mailing address:
  • Phone: 773-488-7744
  • Fax: 773-488-3669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036072781
License Number StateIL

VIII. Authorized Official

Name: DR. HARIVADAN K GANDHI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 773-488-7744