Healthcare Provider Details

I. General information

NPI: 1912004458
Provider Name (Legal Business Name): DIVYAKANT B GANDHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DEEPAK B GANDHI MD

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15855 19 MILE RD
CLINTON TOWNSHIP MI
48038-3504
US

IV. Provider business mailing address

1 FORD PL STE 3A
DETROIT MI
48202-3450
US

V. Phone/Fax

Practice location:
  • Phone: 586-263-2300
  • Fax:
Mailing address:
  • Phone: 313-874-4806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301061777
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01093329A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number01093329A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number4301061777
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: