Basic Information
Provider Information
NPI: 1003005778
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GANDHI
FirstName: BELA
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: DEPT 781625
Address2:  
City: DETROIT
State: MI
PostalCode: 482781625
CountryCode: US
TelephoneNumber: 6143558004
FaxNumber: 6143552220
Practice Location
Address1: 700 CHILDRENS DR
Address2:  
City: COLUMBUS
State: OH
PostalCode: 432052664
CountryCode: US
TelephoneNumber: 6147228212
FaxNumber: 6147223235
Other Information
ProviderEnumerationDate: 10/18/2007
LastUpdateDate: 06/09/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0804X35.090657OHY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry

ID Information
IDTypeStateIssuerDescription
284667505OH MEDICAID
BG924671801OHDEAOTHER
278629405OH MEDICAID


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