Healthcare Provider Details

I. General information

NPI: 1639481591
Provider Name (Legal Business Name): KRANTI GOLLAPUDI DASGUPTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRANTI GOLLAPUDI M.D.

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 E GOLF RD 2ND FL.
ARLINGTON HEIGHTS IL
60005-5700
US

IV. Provider business mailing address

825 E GOLF RD 2ND FL.
ARLINGTON HEIGHTS IL
60005-5700
US

V. Phone/Fax

Practice location:
  • Phone: 847-640-9180
  • Fax: 847-640-4450
Mailing address:
  • Phone: 847-640-9180
  • Fax: 847-640-4450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125.058864
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: