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General NPI Number Information
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NPI Number | 1699870931
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Entity Type | Organization
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Legal Business Name | ANIL GUPTA M D
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 421 S. MAIN
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City | COLUMBIA
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State | IL
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Zip | 62236
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Country | US
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Telephone | 618-281-7151
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Fax | 618-281-6680
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Provider Business Mailing Address
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Address Line | PO BOX 522 421 SOUTH MAIN STREET
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City | COLUMBIA
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State | IL
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Zip | 62236
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Country | US
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Telephone | 618-281-7151
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Fax | 618-281-6680
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Authorized Official
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Title or Position | OWNER
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Name | ANIL GUPTA
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Credential | M.D.
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Telephone | 618-281-7151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036086275
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License Number State | IL
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