Individual
DR. NIMISHA GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1401 E STATE ST, ROCKFORD, IL 61104-2315
(779) 696-4400
Mailing address
PO BOX 78866, MILWAUKEE, WI 53278-8866
(779) 696-7150
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
4301083163
MI
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
036-137025
IL
2080N0001X
Neonatal-Perinatal Medicine Physician
4301083163
MI
Other
Enumeration date
05/18/2007
Last updated
04/01/2021
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