Healthcare Provider Details

I. General information

NPI: 1790148112
Provider Name (Legal Business Name): BHAVIKA GANDHI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2016
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 11TH ST
WICHITA FALLS TX
76301
US

IV. Provider business mailing address

1631 11TH ST UNIT B
WICHITA FALLS TX
76301-4332
US

V. Phone/Fax

Practice location:
  • Phone: 940-263-3000
  • Fax: 940-263-3018
Mailing address:
  • Phone: 940-263-3000
  • Fax: 940-263-3018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberS1097
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: