MEDICARE: PARUL GUPTA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	036104124	IL
2	207V00000X	Obstetrics & Gynecology Physician	036104124	IL

General Provider Information

NPI Number	:	1023001187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PARUL GUPTA M.D.

Provider Business Mailing Address
First Line	:	680 N LAKE SHORE DR
Second Line	:	#824
City	:	CHICAGO
State	:	IL
Zip	:	60611-4546
Country	:	US
Telephone Number	:	312-943-3300
Fax Number	:	312-266-4591

Provider Business Practice Location Address
First Line	:	680 N LAKE SHORE DR
Second Line	:	#824
City	:	CHICAGO
State	:	IL
Zip	:	60611-4546
Country	:	US
Telephone Number	:	312-943-3300
Fax Number	:	312-266-4591

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	02/11/2025

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