Healthcare Provider Details

I. General information

NPI: 1407387152
Provider Name (Legal Business Name): SWAPNA GUDIPATI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2017
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 W DIVISION ST STE 100
CHICAGO IL
60622-3093
US

IV. Provider business mailing address

2233 W DIVISION ST
CHICAGO IL
60622-8151
US

V. Phone/Fax

Practice location:
  • Phone: 773-326-2244
  • Fax: 773-342-3344
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301502289
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036171686
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number036171686
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: