Organization
GAUTAM GUPTA MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GAUTAM GUPTA MD (OWNER)
(815) 229-1899
Entity
Organization
Contact information
Practice address
6090 STRATHMOOR DR, ROCKFORD, IL 61107-6628
(815) 229-1899
Mailing address
4525 FOREST VIEW AVE, ROCKFORD, IL 61108-6406
(815) 965-8505
(815) 965-8440
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
05/05/2010
Last updated
05/05/2010
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