Provider Demographics
NPI:1003044280
Name:MITTAL, NUPUR (MD)
Entity Type:Individual
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First Name:NUPUR
Middle Name:
Last Name:MITTAL
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Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1620 W. CONGRESS PKWY SUITE 447 PAVILION
Mailing Address - Street 2:C/O EMILY SUSSKIND, RUSH UNIVERSITY MEDICAL CENTER,
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:312-942-7098
Mailing Address - Fax:312-942-2876
Practice Address - Street 1:1725 W. HARRISON ST SUITE 710
Practice Address - Street 2:RUSH UNIVERSITY MEDICAL CENTER,
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-942-5983
Practice Address - Fax:312-563-2519
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2015-11-18
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Provider Licenses
StateLicense IDTaxonomies
IL036-131173208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics