Provider Demographics
NPI:1912004458
Name:GANDHI, DIVYAKANT B (MD)
Entity type:Individual
Prefix:
First Name:DIVYAKANT
Middle Name:B
Last Name:GANDHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DEEPAK
Other - Middle Name:B
Other - Last Name:GANDHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2651 E DISCOVERY PKWY
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47408-9059
Practice Address - Country:US
Practice Address - Phone:812-334-5081
Practice Address - Fax:812-334-5091
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01093329A208600000X, 208G00000X
MI4301061777208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI330C313780OtherBLUE CROSS BLUE SHIELD
MI330C313780OtherCOMMUNITY BLUE
MI1800007OtherPHYSICIAN HEALTH PLAN
MI4840090Medicaid
MI1018866OtherHEALTH ADVANTAGE NETWORK
MI330C313780OtherBLUE CROSS COMMUNITY BLUE
MI1018866OtherMCLAREN HEALTH PLAN
MI330C313780OtherBLUE PREFERRED PLUS
IN300096624Medicaid
MI1018866OtherMCLAREN HEALTH PLAN
MI330C313780OtherBLUE CROSS BLUE SHIELD