Healthcare Provider Details

I. General information

NPI: 1164525499
Provider Name (Legal Business Name): HARIVADAN K GANDHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 03/17/2023
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7906 S CRANDON AVE STE 1
CHICAGO IL
60617-1146
US

IV. Provider business mailing address

143 SILO RIDGE ROAD N
ORLAND PARK IL
60467
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:
Title or Position:
Credential:
Phone: