Provider Demographics
NPI:1992896898
Name:GANDIA, ANTONIO (MD)
Entity type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:
Last Name:GANDIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANTONIO
Other - Middle Name:
Other - Last Name:GANDIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 534235
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-4235
Mailing Address - Country:US
Mailing Address - Phone:305-651-2270
Mailing Address - Fax:904-346-0113
Practice Address - Street 1:2001 W 68TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1801
Practice Address - Country:US
Practice Address - Phone:305-823-5000
Practice Address - Fax:904-346-0113
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0053887207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL030416600Medicaid
FL07848OtherBCBS
FL07848AMedicare ID - Type Unspecified
FL07848OtherBCBS