MEDICARE: DR. HARSH V 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	207RG0100X	Gastroenterology Physician	036-059650	IL

General Provider Information

NPI Number	:	1295727436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HARSH V GUPTA MD

Provider Business Mailing Address
First Line	:	20 TOWER CT
Second Line	:	SUITE C
City	:	GURNEE
State	:	IL
Zip	:	60031-5711
Country	:	US
Telephone Number	:	847-244-2960
Fax Number	:	847-244-2986

Provider Business Practice Location Address
First Line	:	800 AUSTIN ST
Second Line	:	SUITE 505 WEST TOWER
City	:	EVANSTON
State	:	IL
Zip	:	60202-3439
Country	:	US
Telephone Number	:	847-491-9020
Fax Number	:	847-491-0182

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	12/28/2021

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