# GAUTAM GUPTA MD LLC

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

## Provider details

- **NPI number:** 1396063046
- **Authorized official:** GAUTAM GUPTA MD (OWNER)
- **Authorized official phone:** (815) 229-1899

## Contact information

- **Practice address:** 6090 STRATHMOOR DR, ROCKFORD, IL 61107-6628
- **Practice address phone:** (815) 229-1899
- **Mailing address:** 4525 FOREST VIEW AVE, ROCKFORD, IL 61108-6406
- **Mailing address phone:** (815) 965-8505
- **Mailing address fax:** (815) 965-8440

## Taxonomy

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

## Other

- **Enumeration date:** 05/05/2010
- **Last updated:** 05/05/2010