Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 4301067153 | MI |
NPI | 1003995689 |
---|---|
Provider Name | Ravinder Gandhi |
First Address | Wyandotte, MI 48192-2312 |
Second Address | Wyandotte, MI 48192-2312 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 29/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Y53539 | (02) | MI |