Healthcare Provider Details

I. General information

NPI: 1700879236
Provider Name (Legal Business Name): DIPANKAR S DASGUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 04/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 E ERIE ST SUITE 2200
CHICAGO IL
60611-2987
US

IV. Provider business mailing address

259 E ERIE ST SUITE 2200
CHICAGO IL
60611-2987
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-6000
  • Fax: 312-926-6344
Mailing address:
  • Phone: 312-926-6000
  • Fax: 312-926-6344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036049471
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: