Provider Demographics
NPI:1063466738
Name:GUPTA, ANSHU (MD)
Entity Type:Individual
Prefix:DR
First Name:ANSHU
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 AUSTIN STREET
Mailing Address - Street 2:SUITE 404 WEST TOWER
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202
Mailing Address - Country:US
Mailing Address - Phone:847-650-8044
Mailing Address - Fax:888-809-7232
Practice Address - Street 1:800 AUSTIN STREET
Practice Address - Street 2:SUITE 404 WEST TOWER
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202
Practice Address - Country:US
Practice Address - Phone:847-650-8044
Practice Address - Fax:888-809-7232
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-094836207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL627280Medicare PIN
ILG89157Medicare UPIN