Active NPI
Anuja Gupta, MD
- Pediatric Cardiology Physician
- Kankakee, IL
National Provider Identifier
1013938257
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Cardiology Physician
- License
- 2004-0758
- Practice address
- 500 N Wall St
Suite 100
Kankakee, IL 60901-2942 - Phone
- (815) 933-2557
- NPI assigned
- Jul 22, 2006
- Last updated
- Aug 24, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Cardiology Physician | 2080P0202X | 2004-0758 | NM | Primary |
Addresses
Primary practice location
500 N Wall St
Suite 100
Kankakee, IL 60901-2942
Mailing address
1905 W Court St
Kankakee, IL 60901-3163
Phone (815) 935-7256
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2004-0758 | NM | MD | Pediatric Cardiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153526400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1282608000000",
"number": "1013938257",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1905 W COURT ST",
"city": "KANKAKEE",
"state": "IL",
"postal_code": "609013163",
"telephone_number": "815-935-7256"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 N WALL ST",
"address_2": "SUITE 100",
"city": "KANKAKEE",
"state": "IL",
"postal_code": "609012942",
"telephone_number": "815-933-2557"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUPTA",
"first_name": "ANUJA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-22",
"last_updated": "2010-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0202X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Cardiology",
"state": "NM",
"license": "2004-0758",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kankakee, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.