Provider Demographics
NPI:1467422568
Name:SENGUPTA, ELIZABETH ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ELLEN
Last Name:SENGUPTA
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 1:2900 N LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5640
Mailing Address - Country:US
Mailing Address - Phone:773-665-3679
Mailing Address - Fax:773-665-3612
Practice Address - Street 1:2900 N LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5640
Practice Address - Country:US
Practice Address - Phone:773-665-3679
Practice Address - Fax:773-665-3612
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036072945207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000383415OtherANTHEM BCBS
IN100378240Medicaid
IL036072945Medicaid
P00296508OtherRAILROAD MEDICARE
ILF400198620Medicare PIN
IN000000383415OtherANTHEM BCBS
ILP01433503Medicare PIN
IN233720DMedicare PIN