Healthcare Provider Details

I. General information

NPI: 1841297348
Provider Name (Legal Business Name): SANDRA L GADSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 W 86TH AVE
MERRILLVILLE IN
46410-7086
US

IV. Provider business mailing address

120 W 22ND ST STE 200
OAK BROOK IL
60523-1563
US

V. Phone/Fax

Practice location:
  • Phone: 219-791-1555
  • Fax: 219-791-1560
Mailing address:
  • Phone: 630-575-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036058441
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number10129625A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: