Provider Demographics
NPI:1730126087
Name:GUTTA, GANDHI MOHANDAS (MD)
Entity type:Individual
Prefix:DR
First Name:GANDHI
Middle Name:MOHANDAS
Last Name:GUTTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:29 NORTH TOWER ROAD
Mailing Address - Street 2:DR GANDHI M GUTTA
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1103
Mailing Address - Country:US
Mailing Address - Phone:630-627-1990
Mailing Address - Fax:630-627-7757
Practice Address - Street 1:29 NORTH TOWER ROAD
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1103
Practice Address - Country:US
Practice Address - Phone:630-627-1990
Practice Address - Fax:630-627-7757
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23362208600000X
CAC51269208600000X
FLME88434208600000X
HI12182208600000X
NE13266208600000X
IL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D14427Medicare UPIN
IL655470Medicare ID - Type Unspecified