MEDICARE: SUNIL GANDHI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	ME0077598	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	P01584464	OTHER	FL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4102369	OTHER	FL	CIGNA
2	1094837	OTHER	FL	WELLCARE
3	44958	OTHER	FL	BCBS
4	5003102	OTHER	FL	AETNA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	14332	OTHER	FL	DIMENSION HEALTH PPO
8	327962	OTHER	FL	AVMED

General Provider Information

NPI Number	:	1265430680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUNIL GANDHI M.D.

Provider Business Mailing Address
First Line	:	2234 COLONIAL BLVD
Second Line	:	ATTN: PAYER CONTRACTING & RELATIONS DEPT.
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1412
Country	:	US
Telephone Number	:	239-931-7342
Fax Number	:	239-931-7385

Provider Business Practice Location Address
First Line	:	2111 SE OCEAN BLVD
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34996-3305
Country	:	US
Telephone Number	:	772-678-4442
Fax Number	:	772-219-5980

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2005
Last Update Date	:	10/12/2016

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Directions to “ SUNIL GANDHI M.D.” Practice Location

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