Healthcare Provider Details

I. General information

NPI: 1477241750
Provider Name (Legal Business Name): MIDWEST DIGESTIVE HEALTH & NUTRITION, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 RAND RD STE 120
DES PLAINES IL
60016-2359
US

IV. Provider business mailing address

1400 S MICHIGAN AVE APT 1203
CHICAGO IL
60605-3720
US

V. Phone/Fax

Practice location:
  • Phone: 312-623-8993
  • Fax:
Mailing address:
  • Phone: 312-767-3244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. NEIL GUPTA
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 312-623-8993