Individual
DIVYAKANT B GANDHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
15855 19 MILE RD, CLINTON TOWNSHIP, MI 48038-3504
(586) 263-2300
Mailing address
1 FORD PL STE 3A, DETROIT, MI 48202-3450
(313) 874-4806
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
01093329A
IN
208600000X
Surgery Physician
4301061777
MI
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
01093329A
IN
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
4301061777
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1018866
HEALTH ADVANTAGE NETWORK
MI
01
—
1800007
PHYSICIAN HEALTH PLAN
MI
05
—
300096624
—
IN
01
—
330C313780
BLUE CROSS BLUE SHIELD
MI
05
—
4840090
—
MI
Enumeration date
09/19/2006
Last updated
04/30/2026
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