Healthcare Provider Details

I. General information

NPI: 1639129661
Provider Name (Legal Business Name): SHARAD GUPTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N WINFIELD RD STE 401
WINFIELD IL
60190-1379
US

IV. Provider business mailing address

25 N WINFIELD RD STE 401
WINFIELD IL
60190-1379
US

V. Phone/Fax

Practice location:
  • Phone: 630-933-4200
  • Fax: 630-933-4210
Mailing address:
  • Phone: 630-933-4200
  • Fax: 630-933-4210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036-106190
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: