Gautam Gupta | |
6090 Strathmoor Dr Suite #4 Rockford IL 61107-6628 | |
(815) 229-1899 | |
(815) 231-1218 |
Full Name | Gautam Gupta |
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Speciality | Internal Medicine |
Location | 6090 Strathmoor Dr, Rockford, Illinois |
Authorized Official Name and Position | Gautam Gupta (SOLE PROPRIETOR) |
Authorized Official Contact | 8152291899 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Gautam Gupta 6090 Strathmoor Dr Suite #4 Rockford IL 61107-6628 Ph: (815) 229-1899 | Gautam Gupta 6090 Strathmoor Dr Suite #4 Rockford IL 61107-6628 Ph: (815) 229-1899 |
NPI Number | 1023177128 |
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Provider Enumeration Date | 12/06/2006 |
Last Update Date | 11/07/2007 |
Identifier | Type | State | Issuer |
---|---|---|---|
1023177128 | NPI | - | NPPES |
0010100611 | Other | IL | BCBS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (Illinois) | Primary |
Rockford School District Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 401 N Gardiner Ave, Rockford, IL 61107 Phone: 815-398-3976 | |
Rockford Adult Medicine Associates S C Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 534 Roxbury Rd, Rockford, IL 61107 Phone: 815-381-7005 | |