MEDICARE: DR. NAVYASH 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	2086S0129X	Vascular Surgery Physician	036095219	IL
2	2086S0129X	Vascular Surgery Physician	G145199	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	537830145	OTHER	IL	MEDICARE LAKE
4	944351142	OTHER	IL	MEDICARE COOK

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	11345469	OTHER		CAQH

General Provider Information

NPI Number	:	1235103888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NAVYASH GUPTA M.D.

Provider Business Mailing Address
First Line	:	9977 WOODS DR
Second Line	:	SUITE 355
City	:	SKOKIE
State	:	IL
Zip	:	60077-1057
Country	:	US
Telephone Number	:	847-663-8050
Fax Number	:	847-663-8054

Provider Business Practice Location Address
First Line	:	99 N LA CIENEGA BLVD STE 307
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-2283
Country	:	US
Telephone Number	:	310-423-7040
Fax Number	:

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

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	12/14/2023

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Directions to “ DR. NAVYASH GUPTA M.D.” Practice Location

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