Basic Information
| Provider Information | |||||||||
| NPI: | 1972966539 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GANDHI | ||||||||
| FirstName: | NILAY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 451 HEALTH PKWY STE G | ||||||||
| Address2: | |||||||||
| City: | PAW PAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490798242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2696683348 | ||||||||
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| Practice Location | |||||||||
| Address1: | 451 HEALTH PKWY STE G | ||||||||
| Address2: | |||||||||
| City: | PAW PAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2696683348 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2016 | ||||||||
| LastUpdateDate: | 10/08/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 11018875A | IN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 4301118955 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.