MEDICARE: MAYURI P GUPTA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD429729	PA
2	207RG0100X	Gastroenterology Physician	ME 109736	FL

General Provider Information

NPI Number	:	1114075785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYURI P GUPTA MD

Provider Business Mailing Address
First Line	:	5340 N FEDERAL HWY STE 110
Second Line	:
City	:	LIGHTHOUSE POINT
State	:	FL
Zip	:	33064-7058
Country	:	US
Telephone Number	:	954-425-2480
Fax Number	:	954-428-2904

Provider Business Practice Location Address
First Line	:	5340 N FEDERAL HWY STE 110
Second Line	:
City	:	LIGHTHOUSE POINT
State	:	FL
Zip	:	33064-7058
Country	:	US
Telephone Number	:	954-425-2480
Fax Number	:	954-428-2904

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	10/25/2021

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Directions to “ MAYURI P GUPTA MD” Practice Location

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