Individual
SANDRA L GADSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
90 W 86TH AVE, MERRILLVILLE, IN 46410-7086
(219) 791-1555
(219) 791-1560
Mailing address
120 W 22ND ST STE 200, OAK BROOK, IL 60523-1563
(630) 575-5000
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
036058441
IL
207RN0300X
Nephrology Physician
Primary
10129625A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000095599
ANTHEM PROVIDER NUMBER
IN
01
—
090001077
BCBS ILLINOIS
IL
05
—
100360450B
—
IN
Enumeration date
06/30/2005
Last updated
05/31/2022
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