Healthcare Provider Details

I. General information

NPI: 1467521278
Provider Name (Legal Business Name): ASHA GANDHI M.D.S.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 GREENLEAF AVE STE F
PARK CITY IL
60085-5701
US

IV. Provider business mailing address

351 GREENLEAF AVE STE F
PARK CITY IL
60085-5701
US

V. Phone/Fax

Practice location:
  • Phone: 847-406-3340
  • Fax: 847-406-3345
Mailing address:
  • Phone: 847-406-3340
  • Fax: 847-406-3345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036051633
License Number StateIL

VIII. Authorized Official

Name: MRS. ASHA GANDHI
Title or Position: PRESIDENT
Credential: MD
Phone: 847-406-3340