Provider Demographics
NPI:1386687556
Name:DASGUPTA, TAPAS (MD)
Entity Type:Individual
Prefix:DR
First Name:TAPAS
Middle Name:
Last Name:DASGUPTA
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 1:6747 FIELDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5262
Mailing Address - Country:US
Mailing Address - Phone:773-333-5874
Mailing Address - Fax:776-783-8794
Practice Address - Street 1:9445 INDIANAPOLIS BLVD STE G1
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-2648
Practice Address - Country:US
Practice Address - Phone:219-616-0197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036093907170100000X
IN01047887A208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036093907Medicaid
ILG45668Medicare UPIN
IL036093907Medicaid