Healthcare Provider Details

I. General information

NPI: 1811256399
Provider Name (Legal Business Name): SHRUTI GUPTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2012
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 N BARRINGTON RD STE 3450
HOFFMAN ESTATES IL
60169-1031
US

IV. Provider business mailing address

1555 N BARRINGTON RD STE 3450
HOFFMAN ESTATES IL
60169-1031
US

V. Phone/Fax

Practice location:
  • Phone: 847-882-2400
  • Fax:
Mailing address:
  • Phone: 847-882-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036137115
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036137115
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: