Individual
DR. RENU GUPTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1221 LONGFORD ST, WOODRIDGE, IL 60517-7748
(630) 910-0683
(630) 910-0685
Mailing address
1221 LONGFORD ST, WOODRIDGE, IL 60517-7748
(630) 910-0683
(630) 910-0685
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036-084024
IL
2084P0800X
Psychiatry Physician
Primary
036-084024
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02221309
BLUE CROSS BLUE SHIELD
IL
05
—
036084024
—
IL
Enumeration date
03/09/2007
Last updated
02/25/2020
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