Healthcare Provider Details

I. General information

NPI: 1841254232
Provider Name (Legal Business Name): DEVANG V GANDHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6030 W CAPITOL DR
MILWAUKEE WI
53216-2118
US

IV. Provider business mailing address

6030 W CAPITOL DR
MILWAUKEE WI
53216-2118
US

V. Phone/Fax

Practice location:
  • Phone: 414-442-6970
  • Fax:
Mailing address:
  • Phone: 414-442-6970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number36604
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: