Provider Demographics
NPI:1548491343
Name:KHANDPUR, GUNJAN (MD)
Entity type:Individual
Prefix:
First Name:GUNJAN
Middle Name:
Last Name:KHANDPUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13340 W BLUEMOUND RD
Mailing Address - Street 2:UNIT 2
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122-2537
Mailing Address - Country:US
Mailing Address - Phone:262-312-0695
Mailing Address - Fax:
Practice Address - Street 1:13340 W BLUEMOUND RD
Practice Address - Street 2:UNIT 2
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2537
Practice Address - Country:US
Practice Address - Phone:262-312-0695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI553580202084P0800X, 2084P0804X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry