Individual
NARENDRA KUMAR GUPTA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D., F.A.C.S.
Contact information
Practice address
1054 MARTIN LUTHER KING DRIVE, SUITE 125, CENTRALIA, IL 62801
(618) 532-1155
(618) 532-1117
Mailing address
1054 MARTIN LUTHER KING DRIVE, SUITE 125, CENTRALIA, IL 62801
(618) 532-1155
(618) 532-1117
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02900086
BLUE CROSS/BLUE SHIELD
IL
Enumeration date
04/17/2006
Last updated
07/09/2007
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