Provider Demographics
NPI:1235103888
Name:GUPTA, NAVYASH (MD)
Entity Type:Individual
Prefix:DR
First Name:NAVYASH
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9977 WOODS DR
Mailing Address - Street 2:SUITE 355
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1057
Mailing Address - Country:US
Mailing Address - Phone:847-663-8050
Mailing Address - Fax:847-663-8054
Practice Address - Street 1:99 N LA CIENEGA BLVD STE 307
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2283
Practice Address - Country:US
Practice Address - Phone:310-423-7040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360952192086S0129X
CAG1451992086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036095219Medicaid
11345469OtherCAQH
IL537830145OtherMEDICARE LAKE
IL944351142OtherMEDICARE COOK
IL537830145OtherMEDICARE LAKE