MEDICARE: VIVEK GUPTA, M.D., S.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1033300694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIVEK GUPTA, M.D., S.C.

Provider Business Mailing Address
First Line	:	PO BOX 3603
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60522-3603
Country	:	US
Telephone Number	:	773-772-7858
Fax Number	:	773-276-6668

Provider Business Practice Location Address
First Line	:	2720 W DIVISION ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2853
Country	:	US
Telephone Number	:	773-523-8600
Fax Number	:	773-687-9545

Authorized Official
Title or Position	:	PRESIDENT
Name	:	VIVEK GUPTA
Credential	:
Telephone Number	:	773-772-7858

Provider Enumeration Date	:	08/07/2007
Last Update Date	:	08/29/2023

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