Basic Information
| Provider Information | |||||||||
| NPI: | 1619147279 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | GUPTA | ||||||||
| FirstName: | MADHU | ||||||||
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| NamePrefix: | MISS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 136 BIESTERFIELD ROAD | ||||||||
| Address2: | MEXIAN BROTHER CORPORATE HEALTH | ||||||||
| City: | ELK GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479815910 | ||||||||
| FaxNumber: | 8479565420 | ||||||||
| Practice Location | |||||||||
| Address1: | 136 BIESTERFIELD ROAD | ||||||||
| Address2: | MEXIAN BROTHER CORPORATE HEALTH | ||||||||
| City: | ELK GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479815910 | ||||||||
| FaxNumber: | 8479565420 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2008 | ||||||||
| LastUpdateDate: | 08/04/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 070007516 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.