Individual
JAGJEEVAN RAO GANDRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3723 FRANKLIN ST, MICHIGAN CITY, IN 46360-7310
(219) 874-3313
(219) 878-2330
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01045405A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000371639
ANTHEM
IN
05
—
200096690
—
IN
Enumeration date
09/19/2005
Last updated
04/13/2023
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