Provider Demographics
NPI:1962556944
Name:GANDHI, JANKI J (PA-C)
Entity type:Individual
Prefix:
First Name:JANKI
Middle Name:J
Last Name:GANDHI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JANKI
Other - Middle Name:JIGISH
Other - Last Name:THAKORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:25 N WINFIELD RD STE 500
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1379
Mailing Address - Country:US
Mailing Address - Phone:630-232-0280
Mailing Address - Fax:630-933-3626
Practice Address - Street 1:25 N WINFIELD RD STE 500
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1379
Practice Address - Country:US
Practice Address - Phone:630-232-0280
Practice Address - Fax:630-933-3626
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00568363A00000X
IL085003460363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206147OtherMEDICARE PTAN (GROUP)
IL206147234OtherMEDICARE PTAN (INDIVIDUAL)