| Gautam Gupta | |
|
6090 Strathmoor Dr Suite #4 Rockford IL 61107-6628 | |
| (815) 229-1899 | |
| (815) 231-1218 |
| Full Name | Gautam Gupta |
|---|---|
| Speciality | Internal Medicine |
| Location | 6090 Strathmoor Dr, Rockford, Illinois |
| Authorized Official Name and Position | Gautam Gupta (SOLE PROPRIETOR) |
| Authorized Official Contact | 8152291899 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gautam Gupta 6090 Strathmoor Dr Suite #4 Rockford IL 61107-6628 Ph: (815) 229-1899 | Gautam Gupta 6090 Strathmoor Dr Suite #4 Rockford IL 61107-6628 Ph: (815) 229-1899 |
| NPI Number | 1023177128 |
|---|---|
| Provider Enumeration Date | 12/06/2006 |
| Last Update Date | 11/07/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023177128 | NPI | - | NPPES |
| 0010100611 | Other | IL | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (Illinois) | Primary |
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