Provider Demographics
NPI:1134613458
Name:GUPTA, NEHA (DO)
Entity type:Individual
Prefix:
First Name:NEHA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 RAYMOND DR STE 300
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-9792
Mailing Address - Country:US
Mailing Address - Phone:630-355-5302
Mailing Address - Fax:630-778-6088
Practice Address - Street 1:636 RAYMOND DR STE 300
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-9792
Practice Address - Country:US
Practice Address - Phone:630-355-5302
Practice Address - Fax:630-778-6088
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036154559207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program