Healthcare Provider Details

I. General information

NPI: 1487828653
Provider Name (Legal Business Name): NEIL GUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
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: 312-767-3244
  • Fax:
Mailing address:
  • Phone: 312-767-3244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2011001553
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number01092779A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036120055
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: