Individual
GARIMA GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
11104 PARKVIEW CIRCLE DR STE 330, FORT WAYNE, IN 46845-1674
(260) 471-5114
(260) 417-5507
Mailing address
120 W 22ND ST, OAK BROOK, IL 60523-1557
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
01066542A
IN
207RN0300X
Nephrology Physician
35.098119
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00246075
—
NY
01
—
200945110
MEDICAID
IN
05
—
3002762
—
OH
Enumeration date
05/15/2007
Last updated
03/06/2025
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