Organization
GUPTA INTERNAL MEDICINE ASSOCIATES,S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAJ G GUPTA MD (OWNER)
(708) 525-5008
Entity
Organization
Contact information
Practice address
17850 SOUTH KEDZIE AVENUE, SUITE 3300, HAZEL CREST, IL 60429
(708) 799-6055
Mailing address
222 E PEARSON ST, UNIT 2705, CHICAGO, IL 60611-7347
(708) 525-5008
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1619980
BC/BS PROVIDER #
—
01
—
CD2711
RAILROAD MEDICARE
—
Enumeration date
05/30/2007
Last updated
03/24/2017
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