| NPI | 1023177128 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GAUTAM GUPTA Sole Proprietor 815-229-1899 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036061001) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2007-11-07 |