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General NPI Number Information
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NPI Number | 1477241750
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Entity Type | Organization
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Legal Business Name | MIDWEST DIGESTIVE HEALTH & NUTRITION, PLLC
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Dates
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Enumeration Date | 04/25/2023
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 900 RAND RD STE 120
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City | DES PLAINES
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State | IL
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Zip | 60016-2359
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Country | US
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Telephone | 312-623-8993
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 S MICHIGAN AVE APT 1203
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City | CHICAGO
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State | IL
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Zip | 60605-3720
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Country | US
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Telephone | 312-767-3244
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. NEIL GUPTA
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Credential | MD
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Telephone | 312-623-8993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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