# GAUTAM GUPTA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023177128
- **Authorized official:** GAUTAM GUPTA M.D. (SOLE PROPRIETOR)
- **Authorized official phone:** (815) 229-1899

## Contact information

- **Practice address:** 6090 STRATHMOOR DR, SUITE \#4, ROCKFORD, IL 61107-6628
- **Practice address phone:** (815) 229-1899
- **Practice address fax:** (815) 231-1218
- **Mailing address:** 6090 STRATHMOOR DR, SUITE \#4, ROCKFORD, IL 61107-6628
- **Mailing address phone:** (815) 229-1899
- **Mailing address fax:** (815) 231-1218

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | IL | Yes |

## Other

- **Enumeration date:** 12/06/2006
- **Last updated:** 11/07/2007