Healthcare Provider Details

I. General information

NPI: 1053330209
Provider Name (Legal Business Name): TAPAS DASGUPTA MDSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 05/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7845 S COTTAGE GROVE AVE SUITE 109
CHICAGO IL
60619-3100
US

IV. Provider business mailing address

6747 FIELDSTONE DR
BURR RIDGE IL
60527-5262
US

V. Phone/Fax

Practice location:
  • Phone: 312-842-7822
  • Fax: 866-441-0698
Mailing address:
  • Phone: 312-842-7822
  • Fax: 866-441-0698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number036093907
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number036093907
License Number StateIL

VIII. Authorized Official

Name: DR. TAPAS DASGUPTA
Title or Position: DOCTOR
Credential: MD
Phone: 312-224-8269