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General NPI Number Information
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NPI Number | 1629123377
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Entity Type | Individual
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Provider Name | KIRAN R GANDHI M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 01/10/2019
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Provider Practice Location Address
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Address Line | 2701 W 68TH ST FLOOR 2
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City | CHICAGO
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State | IL
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Zip | 60629-1813
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Country | US
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Telephone | 773-884-9000
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Fax | 708-423-2991
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Provider Business Mailing Address
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Address Line | 9532 MINNICK AVE APT 2E
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City | OAK LAWN
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State | IL
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Zip | 60453-9012
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Country | US
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Telephone | 708-529-3027
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Fax | 708-529-3657
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 036066641
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License Number State | IL
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