MEDICARE: ASHUTOSH 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	036052219	IL

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

General Provider Information

NPI Number	:	1528065646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHUTOSH GUPTA MD

Provider Business Mailing Address
First Line	:	855 MADISON ST
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-4420
Country	:	US
Telephone Number	:	708-492-4077
Fax Number	:	708-386-2839

Provider Business Practice Location Address
First Line	:	7531 S STONY ISLAND AVE
Second Line	:	SUITE 158 & 160
City	:	CHICAGO
State	:	IL
Zip	:	60649-3954
Country	:	US
Telephone Number	:	773-947-2289
Fax Number	:	773-493-1430

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	07/26/2013

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