Provider Demographics
NPI:1366698482
Name:GUPTA, RAINA SUSHIL (MD)
Entity type:Individual
Prefix:
First Name:RAINA
Middle Name:SUSHIL
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 1:3000 N. HALSTED ST.
Mailing Address - Street 2:SUITE 703
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657
Mailing Address - Country:US
Mailing Address - Phone:773-296-6666
Mailing Address - Fax:713-296-9999
Practice Address - Street 1:9110 COLLEGE POINTE CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3244
Practice Address - Country:US
Practice Address - Phone:239-208-2212
Practice Address - Fax:239-208-3994
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD609325922084N0400X
TXTM008132084N0400X
TN589062084N0400X
ORMD1918922084N0400X
OH35.1355072084N0400X
NY2979322084N0400X
NH195842084N0400X
ND156892084N0400X
GA837972084N0400X
FLME1392962084N0400X
MI43011168462084N0400X
IL1250526002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3118715Medicaid