Provider Demographics
NPI:1750442422
Name:DASGUPTA, SUNAVO (MD)
Entity Type:Individual
Prefix:
First Name:SUNAVO
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 1:1365 WILEY ROAD
Mailing Address - Street 2:SUITE 153
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4357
Mailing Address - Country:US
Mailing Address - Phone:847-519-4701
Mailing Address - Fax:847-519-4707
Practice Address - Street 1:1365 WILEY ROAD
Practice Address - Street 2:SUITE 153
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4357
Practice Address - Country:US
Practice Address - Phone:847-519-4701
Practice Address - Fax:847-519-4707
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036122789207L00000X, 207LP2900X
PAMT186102207L00000X
CAC171447207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036122789Medicaid
IL217074001Medicare PIN
IL217075001Medicare PIN