# GUPTA MEDICAL CLINIC LTD

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

## Provider details

- **NPI number:** 1942352547
- **Authorized official:** DR. SANJEEV GUPTA MD (OWNER)
- **Authorized official phone:** (815) 459-8240

## Contact information

- **Practice address:** 284 MEMORIAL CT STE B, CRYSTAL LAKE, IL 60014-6231
- **Practice address phone:** (815) 459-8240
- **Practice address fax:** (815) 459-8470
- **Mailing address:** 284 MEMORIAL CT STE B, CRYSTAL LAKE, IL 60014-6231
- **Mailing address phone:** (815) 459-8240
- **Mailing address fax:** (815) 459-8470

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 036100728 | IL | Yes |

## Other

- **Enumeration date:** 01/17/2007
- **Last updated:** 11/12/2009