Individual
DR. PAVAN KUMAR GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
THREE SAINT ELIZABETH BLVD STE 2800, O FALLON, IL 62269-1282
(618) 233-6044
(833) 973-4218
Mailing address
THREE SAINT ELIZABETH BLVD STE 2800, O FALLON, IL 62269-1282
(618) 233-6044
(833) 973-4218
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301083827
MI
207R00000X
Internal Medicine Physician
MD13290
RI
207RC0000X
Cardiovascular Disease Physician
Primary
036130576
IL
208M00000X
Hospitalist Physician
4301083827
MI
390200000X
Student in an Organized Health Care Education/Training Program
4301083827
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036130576
—
IL
Enumeration date
03/26/2007
Last updated
12/21/2021
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