| Anil Gupta M.d. | |
|
421 S. Main Columbia IL 62236 | |
| (618) 281-7151 | |
| (618) 281-6680 |
| Full Name | Anil Gupta M.d. |
|---|---|
| Speciality | Family Medicine |
| Location | 421 S. Main, Columbia, Illinois |
| Authorized Official Name and Position | Anil Gupta (OWNER) |
| Authorized Official Contact | 6182817151 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Anil Gupta M.d. Po Box 522 421 South Main Street Columbia IL 62236 Ph: (618) 281-7151 | Anil Gupta M.d. 421 S. Main Columbia IL 62236 Ph: (618) 281-7151 |
| NPI Number | 1699870931 |
|---|---|
| Provider Enumeration Date | 09/13/2006 |
| Last Update Date | 11/28/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699870931 | NPI | - | NPPES |
| 036086275 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036086275 (Illinois) | Primary |
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