Individual
SHIVANI GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
4400 W 95TH ST STE 306, OAK LAWN, IL 60453-2659
(708) 684-5428
(708) 684-2079
Mailing address
1111 MEDICAL CENTER BLVD STE S750, MARRERO, LA 70072-3197
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
036-161214
IL
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
MD320466
LA
Other
Enumeration date
05/27/2014
Last updated
07/05/2023
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