Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 170100000X | Medical Geneticist | 036093907 | IL |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 01047887A | IN |
NPI | 1386687556 |
---|---|
Provider Name | Dr. Tapas Dasgupta |
First Address | Burr Ridge, IL 60527-5262 |
Second Address | Highland, IN 46322-2648 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 17/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036093907 | (05) | IL |
G45668 | (02) | IL |