Organization
GUPTA MDSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAJ G GUPTA MD (OWNER)
(708) 525-5008
Entity
Organization
Contact information
Practice address
17850 SOUTH KEDZIE AVENUE, SUITE 3300, HAZEL CREST, IL 60429
(708) 799-6055
Mailing address
222 E PEARSON ST, UNIT 2705, CHICAGO, IL 60611-7347
(708) 525-5008
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
—
—
207RS0012X
Sleep Medicine (Internal Medicine) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21609346
BC/BS PROVIDER # FOR GUPTA MD SC
—
01
—
CD2646
RAILROAD MEDICARE
—
Enumeration date
04/02/2007
Last updated
03/24/2017
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