Healthcare Provider Details

I. General information

NPI: 1689834418
Provider Name (Legal Business Name): CHARU GUPTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 N MILWAUKEE AVE
VERNON HILLS IL
60061
US

IV. Provider business mailing address

225 N MILWAUKEE AVE
VERNON HILLS IL
60061-4304
US

V. Phone/Fax

Practice location:
  • Phone: 847-663-8410
  • Fax: 847-570-1865
Mailing address:
  • Phone: 847-663-8410
  • Fax: 847-570-1865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036142074
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036142074
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number036142074
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: