Healthcare Provider Details

I. General information

NPI: 1548711971
Provider Name (Legal Business Name): AMIT GANDHI FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5717 HIGHLAND DR
ROLLING MEADOWS IL
60067-2581
US

IV. Provider business mailing address

5717 HIGHLAND DR
ROLLING MEADOWS IL
60067-2581
US

V. Phone/Fax

Practice location:
  • Phone: 847-757-0360
  • Fax:
Mailing address:
  • Phone: 847-757-0360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.407978
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.014709
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: