Organization
GUPTA MDSC
Active
Organization
GUPTA MDSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAJ G GUPTA (OWNER)
(708) 799-6055
Entity
Organization
Contact information
Practice address
17850 KEDZIE AVE STE 3300, HAZEL CREST, IL 60429-2086
(708) 799-8440
Mailing address
17850 SOUTH KEDZIE AVENUE, SUITE 3300, HAZEL CREST, IL 60429
(708) 799-6055
(708) 799-9931
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
036062946
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036062946
—
IL
01
—
110060487
RR MEDICARE
—
01
—
21609346
BLUE SHIELD
IL
Enumeration date
05/31/2007
Last updated
10/31/2008
Update your record
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