Individual
VIJAY GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8840 CALUMET AVE, SUITE 103, MUNSTER, IN 46321-2545
(219) 836-7246
(219) 836-6454
Mailing address
8840 CALUMET AVE, SUITE 103, MUNSTER, IN 46321-2545
(219) 836-7246
(219) 836-6454
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
01031383A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000091129
BLUE CROSS BLUE SHIELD
IN
01
—
01031383A
BCBS OF ILLINOIS
IL
01
—
01031383A
LICENSE NUMBER
IN
01
—
050056006
MEDICARE RAILROAD
GA
05
—
100188860A
—
IN
Enumeration date
07/18/2005
Last updated
04/02/2019
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