MEDICARE: MUKESH M GANDHI, MD, PA

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	207R00000X	Internal Medicine Physician	14842	SC

General Provider Information

NPI Number	:	1851467203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MUKESH M GANDHI, MD, PA

Provider Business Mailing Address
First Line	:	409 E GEORGIA ST
Second Line	:
City	:	WOODRUFF
State	:	SC
Zip	:	29388-1915
Country	:	US
Telephone Number	:	864-476-7068
Fax Number	:	864-476-7069

Provider Business Practice Location Address
First Line	:	409 E GEORGIA ST
Second Line	:
City	:	WOODRUFF
State	:	SC
Zip	:	29388-1915
Country	:	US
Telephone Number	:	864-476-7068
Fax Number	:	864-476-7069

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	MRS. MINA GANDHI
Credential	:
Telephone Number	:	864-476-7068

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	10/07/2011

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