DR. MANISH GUPTA (NPI# 1558399238) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1558399238 |
Entity Type | Individual |
Full Name | DR. MANISH GUPTA |
Credential | MD |
Practice Address |
420 Ne Glen Oak Ave Ste 401 Peoria IL 61603-3168 |
Mailing Address |
420 Ne Glen Oak Ave Ste 401 Peoria IL 61603-3168 |
Practice Telephone | 3096768123 |
Practice Fax Number | 3096768455 |
Mailing Telephone | 3096768123 |
Mailing Fax Number | 3096248339 |
Enumeration Date | 2006-06-29 |
Last Update Date | 2018-10-29 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 208600000X | Surgery | 036138105 | IL | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
IL | 036138105 | 05 |
Address | Telephone Number | Fax Number |
---|---|---|
430 Maxine Dr, Morton, IL 615502495 | 3092667600 | 3092667680 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1609356625 | Manish Gupta | Technician, Other | 4418 Bluebonnet Dr Ste 401, Stafford, TX 77477-2904 | 2018-08-20 |
1073001772 | Manish Kumar Gupta | Student in an Organized Health Care Education/Training Program | Danbury Hospital, 24 Hospital Avenue, Danbury, CT 06810 | 2018-04-27 |
1528250966 | Manish P Gupta | Internal Medicine | 66 Hawkridge Drive, Las Vegas, NV 89135 | 2007-08-09 |
1891007936 | Manish Gupta | Dentist | 11201 Shaker Blvd Ste 136, Cleveland, OH 44104-3833 | 2010-07-06 |
1770687386 | Manish K Gupta | Orthopaedic Surgery | 9325 Glades Rd, Suite 205, Boca Raton, FL 33434-3988 | 2006-09-12 |
1144262023 | Manish Gupta | Internal Medicine | 777 Walter Reed Blvd, Suite 201, Garland, TX 75042-5727 | 2006-06-12 |
1124005863 | Manish R Gupta | Surgery | 1050 Isaac Streets Dr, Suite 136, Oregon, OH 43616-3291 | 2005-12-23 |
Street Address |
420 NE GLEN OAK AVE STE 401 |
City | PEORIA |
State | IL |
Zip Code | 61603-3168 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1710974597 | Timothy P Oconnor | Transplant Surgery | 420 Ne Glen Oak Ave Ste 401, Peoria, IL 61603 | 2005-10-05 |
1962994707 | Michelle Sue Dehne | Nurse Practitioner | 420 Ne Glen Oak Ave Ste 401, Peoria, IL 61603-3168 | 2018-06-06 |
1780060517 | Danae Smith | Nurse Practitioner | 420 Ne Glen Oak Ave Ste 401, Peoria, IL 61603-3168 | 2015-08-04 |
1568848497 | Sarah Adams | Nurse Practitioner | 420 Ne Glen Oak Ave Ste 401, Peoria, IL 61603-3168 | 2015-08-03 |
1225434772 | Tonya Moore | Registered Nurse | 420 Ne Glen Oak Ave Ste 401, Peoria, IL 61603-3168 | 2014-11-11 |
1497172399 | Jill Oberle | Nurse Practitioner | 420 Ne Glen Oak Ave Ste 401, Peoria, IL 61603-3168 | 2014-03-28 |
1629344064 | David Edward Houser | Internal Medicine | 420 Ne Glen Oak Ave Ste 401, Peoria, IL 61603-3168 | 2012-03-29 |
1538325477 | Raji Jacob | Internal Medicine | 420 Ne Glen Oak Ave Ste 401, Peoria, IL 61603-3168 | 2008-07-30 |
1669648309 | Muhammad Waqar Khattak | Internal Medicine | 420 Ne Glen Oak Ave Ste 401, Peoria, IL 61603 | 2008-05-02 |
1982816237 | Anu Vishwanath | Pediatrics | 420 Ne Glen Oak Ave Ste 401, Suite 401, Peoria, IL 61603-3168 | 2007-05-07 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1598362980 | Courtney Klein | Nurse Practitioner | 1306 N. Berkley Ave, Peoria, IL 61603 | 2020-10-08 |
1114588217 | Kong Xing Wang | Dentist | 320 East Armstrong Ave, Peoria, IL 61603 | 2019-06-28 |
1073015319 | Sara Kristine Rosenbery | Nurse Practitioner | 515 Ne Glen Oak Ave Ste 202, Peoria, IL 61603 | 2018-03-02 |
1861860058 | Jennifer Michelle Kelsey | Clinical Nurse Specialist | 420 Ne Glen Oak Avenue, Suite 401, Peoria, IL 61603 | 2015-09-04 |
1467859793 | Bonnie Lansing | Counselor | 617 N Gendale Avenue, Behavioral Health Adult Program, Peoria, IL 61603 | 2014-12-02 |
1639597172 | Jael K. Mahasi | Counselor | 1800 Ne Perry Avenue, Peoria, IL 61603 | 2014-04-02 |
1992054829 | Justin S Ferragut | Radiology | 530 Northeast Glen Oak Avenue, Peoria, IL 61603 | 2012-09-06 |
1780952994 | Syed Muhammad Tayyab | Internal Medicine | 828 Ne Glen Oak Ave Apt No208a, Peoria, IL 61603 | 2011-12-02 |
1528389079 | St. Francis Medical Center | General Acute Care Hospital | 530 N E Glen Oak Ave, Peoria, IL 61603 | 2010-06-18 |
1780810648 | Children's Home Association of Illinois | Voluntary or Charitable | 400 E. Frye, Peoria, IL 61603 | 2009-06-05 |
Find all providers in zip 61603 |
Taxonomy Code | 208600000X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Surgery |
A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1235760406 | Star Surgery Center, LLC | Surgery | 14155 N 83rd Ave Ste 140, Peoria, AZ 85381-5652 | 2020-01-28 |
1093008237 | Jordan J Glenn | Surgery | 6750 W Thunderbird Rd Ste B-108, Peoria, AZ 85381-5026 | 2011-05-20 |
1023207131 | Comprehensive Breast Center of Arizona Plc | Surgery | 9179 W Thunderbird Rd # 103, Peoria, AZ 85381-4875 | 2007-10-15 |
1659589653 | Matthew Lawrence Lynch | Surgery | 26900 N Lake Pleasant Pkwy, Peoria, AZ 85383-1558 | 2007-05-21 |
1457480063 | Lorin Dixon Whittaker Jr. | Surgery | 624 Ne Glen Oak Ave, 2686, Peoria, IL 61603-3135 | 2007-03-02 |
1639132087 | Brian Edward Prebil | Surgery | 14155 N. 83rd Ave., Ste. A-105, Peoria, AZ 85381 | 2006-04-07 |
1073584470 | Eric L Thomas | Surgery | 14155 N 83rd Ave Ste A105, Peoria, AZ 85381-5640 | 2006-02-01 |
1801874565 | Maqbool B Ali | Surgery | 4930 N Executive Dr, Peoria, IL 61614-4894 | 2006-01-04 |
1518956465 | Leann Cari Allgood | Surgery | 9159 W Thunderbird Rd, Peoria, AZ 85381-4910 | 2005-10-13 |
1225037310 | John J Brothwell | Surgery | 9856 W Villa Lindo Dr, Peoria, AZ 85383-1339 | 2005-07-20 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.