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General NPI Number Information
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NPI Number | 1649340449
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Entity Type | Organization
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Legal Business Name | GANDHI MOHANDAS GUTTA, M.D.S.C
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 29 N TOWER RD
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City | OAK BROOK
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State | IL
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Zip | 60523-1103
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Country | US
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Telephone | 630-627-1990
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Fax | 630-627-7757
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Provider Business Mailing Address
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Address Line | 29 N TOWER RD
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City | OAK BROOK
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State | IL
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Zip | 60523-1103
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Country | US
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Telephone | 630-627-1990
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Fax | 630-627-7757
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GANDHI MOHANDAS GUTTA
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Credential | M.D
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Telephone | 630-627-1990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 36053064
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License Number State | IL
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