Individual
DR. SAMIR GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
601 WALL ST, VALPARAISO, IN 46383-2512
(219) 531-3500
Mailing address
809 S LAFLIN ST, CHICAGO, IL 60607-4025
(312) 738-2524
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
01058932A
IN
2084P0800X
Psychiatry Physician
35044
KY
2084P0800X
Psychiatry Physician
36-110477
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200131910
—
IN
Enumeration date
04/19/2006
Last updated
11/25/2020
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