Provider Demographics
NPI:1023160488
Name:GUPTA, ALEEA (MD)
Entity type:Individual
Prefix:
First Name:ALEEA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 W CHICAGO AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3358
Mailing Address - Country:US
Mailing Address - Phone:630-286-9192
Mailing Address - Fax:386-204-7159
Practice Address - Street 1:211 W CHICAGO AVE STE 210
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521
Practice Address - Country:US
Practice Address - Phone:630-286-9192
Practice Address - Fax:386-204-7159
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69729207Q00000X
IL036123729207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036123729Medicaid
CA00A697290Medicaid
IL036123729Medicaid