Healthcare Provider Details

I. General information

NPI: 1356393730
Provider Name (Legal Business Name): VIPAN KUMAR GUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

943 N PLUM GROVE RD STE B
SCHAUMBURG IL
60173
US

IV. Provider business mailing address

943 N PLUM GROVE RD STE B
SCHAUMBURG IL
60173-4779
US

V. Phone/Fax

Practice location:
  • Phone: 847-952-9140
  • Fax: 847-952-9145
Mailing address:
  • Phone: 847-952-9140
  • Fax: 847-952-9145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036086704
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: