MEDICARE: URVI A GANDHI FNP-BC

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	363LF0000X	Family Nurse Practitioner	209018532	IL

General Provider Information

NPI Number	:	1760953889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	URVI A GANDHI FNP-BC

Provider Business Mailing Address
First Line	:	10116 MANSFIELD AVE
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-4303
Country	:	US
Telephone Number	:	708-785-7929
Fax Number	:

Provider Business Practice Location Address
First Line	:	2307 S CICERO AVE STE 9
Second Line	:
City	:	CICERO
State	:	IL
Zip	:	60804-2451
Country	:	US
Telephone Number	:	708-780-9777
Fax Number	:

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

Provider Enumeration Date	:	12/16/2018
Last Update Date	:	12/16/2018

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