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1073729125

NPI Code Detail

MEDICARE: GARIMA GUPTA MD

MEDICARE: GARIMA GUPTA MD

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	207RN0300X	Nephrology Physician	35.098119	OH
2	207RN0300X	Nephrology Physician	01066542A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073729125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARIMA GUPTA MD

Provider Business Mailing Address
First Line	:	120 W 22ND ST
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1557
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11104 PARKVIEW CIRCLE DR STE 330
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1674
Country	:	US
Telephone Number	:	260-471-5114
Fax Number	:	260-417-5507

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	03/06/2025

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Directions to “ GARIMA GUPTA MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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