Organization
GAUTAM GUPTA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GAUTAM GUPTA M.D. (SOLE PROPRIETOR)
(815) 229-1899
Entity
Organization
Contact information
Practice address
6090 STRATHMOOR DR, SUITE #4, ROCKFORD, IL 61107-6628
(815) 229-1899
(815) 231-1218
Mailing address
6090 STRATHMOOR DR, SUITE #4, ROCKFORD, IL 61107-6628
(815) 229-1899
(815) 231-1218
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010100611
BCBS
IL
Enumeration date
12/06/2006
Last updated
11/07/2007
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