Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 036-101308 | IL |
N | 207VG0400X | Gynecologist | 036101308 | IL |
N | 208800000X | Urologist | 036101308 | IL |
NPI | 1821149238 |
---|---|
Provider Name | Sanjay Gandhi |
First Address | Park City, IL 60085-5701 |
Second Address | Park City, IL 60085-5701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2007 |
Last Update Date | 18/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H42764 | (02) | IL |