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General NPI Number Information
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NPI Number | 1184600991
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Entity Type | Individual
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Provider Name | ROOP GUPTA MD
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Gender | Male
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 02/23/2008
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Provider Practice Location Address
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Address Line | 5446 KIRK ST
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City | MORTON GROVE
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State | IL
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Zip | 60053-3611
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Country | US
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Telephone | 312-201-0536
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Fax | 312-201-0538
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Provider Business Mailing Address
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Address Line | 5446 KIRK ST
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City | MORTON GROVE
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State | IL
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Zip | 60053-3611
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Country | US
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Telephone | 312-201-0536
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Fax | 312-201-0538
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 036069245
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License Number State | IL
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