MEDICARE: DR. BRAHMA N 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	207RP1001X	Pulmonary Disease Physician		IL

General Provider Information

NPI Number	:	1073589891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRAHMA N GUPTA M.D.

Provider Business Mailing Address
First Line	:	1730 PARK ST
Second Line	:	SUITE 101
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-2688
Country	:	US
Telephone Number	:	630-718-0200
Fax Number	:	630-718-0900

Provider Business Practice Location Address
First Line	:	326 W 64TH ST
Second Line	:	SUITE 208
City	:	CHICAGO
State	:	IL
Zip	:	60621-3114
Country	:	US
Telephone Number	:	773-962-3900
Fax Number	:

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

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	07/08/2007

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