Gupta, Pavan Kumar
Gupta, Pavan Kumar is an individual health care provider with primary practice located at Three Saint Elizabeth Blvd Ste 2800 , O Fallon IL 62269-1282. He recently has 4 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Hospitalist, Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Cardiovascular Disease. Allopathic & Osteopathic Physicians / Cardiovascular Disease is his primary health care specialty. Gupta, Pavan Kumar can be contacted via phone (618) 233-6044.Contact Information
Primary practice address
Three Saint Elizabeth Blvd Ste 2800
O Fallon IL 62269-1282
Phone: (618) 233-6044
Fax: (833) 973-4218
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Hospitalist | 208M00000X | 4301083827 | Michigan |
| Student, Health Care / Student in an Organized Health Care Education/Training Program | 390200000X | 4301083827 | Michigan |
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | MD13290 | Rhode Island |
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 4301083827 | Michigan |
| Allopathic & Osteopathic Physicians / Cardiovascular Disease | 207RC0000X | 036130576 | Illinois |
Profile Details
| NPI number | 1861519563 |
|---|---|
| LBN Legal business name | Gupta, Pavan Kumar |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 26th, 2007 |
| Last updated | Dec 21st, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1861519563 | NPPES |
| Illinois | MEDICAID | 036130576 |
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