Healthcare Provider Details

I. General information

NPI: 1821160136
Provider Name (Legal Business Name): ATUL N GUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 ESSINGTON RD SUITE 210
JOLIET IL
60435-2801
US

IV. Provider business mailing address

1051 ESSINGTON RD SUITE 210
JOLIET IL
60435-2801
US

V. Phone/Fax

Practice location:
  • Phone: 815-726-1818
  • Fax: 815-726-0232
Mailing address:
  • Phone: 815-726-1818
  • Fax: 815-726-0232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number036105920
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: