Provider Demographics
NPI:1376632976
Name:GUPTA, VIVEK (MD)
Entity Type:Individual
Prefix:DR
First Name:VIVEK
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3603
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-3603
Mailing Address - Country:US
Mailing Address - Phone:773-772-7858
Mailing Address - Fax:773-276-6668
Practice Address - Street 1:2720 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2853
Practice Address - Country:US
Practice Address - Phone:773-523-8600
Practice Address - Fax:773-687-9545
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36116218207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3137024OtherCIGNA
ILQMX000000107962OtherAETNA BETTER HEALTH
ILP00669790OtherRAILROAD MEDICARE
IL20013250OtherHEALTH CONNECT
IL12372491OtherCAQH
ILBG9870660OtherDEA
ILBG9870660OtherDEA
ILP00669790OtherRAILROAD MEDICARE