Provider Demographics
NPI:1265681597
Name:GUJJA, SAPNA R (MD)
Entity Type:Individual
Prefix:DR
First Name:SAPNA
Middle Name:R
Last Name:GUJJA
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 1:1151 W 14TH PL
Mailing Address - Street 2:UNIT # 337
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-2845
Mailing Address - Country:US
Mailing Address - Phone:312-933-1928
Mailing Address - Fax:
Practice Address - Street 1:1151 W 14TH PL
Practice Address - Street 2:UNIT # 337
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-2845
Practice Address - Country:US
Practice Address - Phone:312-933-1928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125053669207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine