Basic Information
| Provider Information | |||||||||
| NPI: | 1316002538 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUPANI | ||||||||
| FirstName: | GITA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1515 SOUTH PRAIRIE AVE | ||||||||
| Address2: | #1306 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3128800087 | ||||||||
| FaxNumber: | 7738342218 | ||||||||
| Practice Location | |||||||||
| Address1: | 1515 SOUTH PRAIRIE AVE | ||||||||
| Address2: | #1306 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606053043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3128800087 | ||||||||
| FaxNumber: | 7738342218 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2006 | ||||||||
| LastUpdateDate: | 12/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 036063645 | IL | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4970778008 | 05 | IL | MEDICAID |