Individual
MICHAEL GANDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
6435 W JEFFERSON BLVD # 434, FORT WAYNE, IN 46804-6203
(260) 436-7875
(260) 732-9812
Mailing address
PO BOX 843603, DALLAS, TX 75284-3603
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
28278333A
IN
367500000X
Certified Registered Nurse Anesthetist
51674
IN
Other
Enumeration date
11/07/2024
Last updated
01/06/2025
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