Organization
NORTHWESTERN MEDICAL ASSOCIATES,S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROOP R GUPTA MD (PRESIDENT)
(312) 201-0536
Entity
Organization
Contact information
Practice address
5446 KIRK ST, MORTON GROVE, IL 60053-3611
(312) 201-0536
(312) 201-0538
Mailing address
5446 KIRK ST, MORTON GROVE, IL 60053-3611
(312) 201-0536
(312) 201-0538
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
036069245
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03606924501
—
IL
01
—
1184600991
NPI
IL
01
—
3160263476
BCBSIL
IL
Enumeration date
07/18/2008
Last updated
07/18/2008
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