Provider Demographics
NPI:1174787337
Name:GANDHI, RAVI HEMANT (MD)
Entity type:Individual
Prefix:DR
First Name:RAVI
Middle Name:HEMANT
Last Name:GANDHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 W FAIRBANKS AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4603
Mailing Address - Country:US
Mailing Address - Phone:407-975-0200
Mailing Address - Fax:
Practice Address - Street 1:1605 W FAIRBANKS AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4603
Practice Address - Country:US
Practice Address - Phone:407-975-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME120563207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012367300Medicaid
FLHW381YMedicare PIN