MEDICARE: DR. VIVEK 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	207R00000X	Internal Medicine Physician	36116218	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00669790	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3137024	OTHER	IL	CIGNA
2	QMX000000107962	OTHER	IL	AETNA BETTER HEALTH
4	20013250	OTHER	IL	HEALTH CONNECT
5	12372491	OTHER	IL	CAQH

General Provider Information

NPI Number	:	1376632976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIVEK GUPTA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 3603
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-3603
Country	:	US
Telephone Number	:	773-772-7858
Fax Number	:	773-276-6668

Provider Business Practice Location Address
First Line	:	2720 W DIVISION ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2853
Country	:	US
Telephone Number	:	773-523-8600
Fax Number	:	773-687-9545

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	03/07/2023

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

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