MEDICARE: DR. MUKESH M 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	207R00000X	Internal Medicine Physician	14842	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	DF4780	OTHER	SC	RR MEDICARE
5	E691833365	OTHER	SC	MEDICARE PTAN
7	110121586	OTHER	SC	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1851467203	OTHER	SC	GROUP NPI NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	570958219	OTHER	SC	BC/BS
6	570958219	OTHER	SC	TAX IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1982608469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MUKESH M GANDHI M.D.

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	03/19/2012

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409 E GEORGIA ST
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