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NPI Code Detail

MEDICARE: MANEESH KUMAR GUPTA M.D.

MEDICARE: MANEESH KUMAR GUPTA M.D.
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
1390200000XStudent in an Organized Health Care Education/Training Program
2207RG0100XGastroenterology Physician57969CO
3207RG0100XGastroenterology PhysicianMD205242LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417271420
Entity Type Code : Individual
Provider Name (Legal Business Name) : MANEESH KUMAR GUPTA M.D.
Provider Business Mailing Address
First Line : 2920 N CASCADE AVE
Second Line : STE 300
City : COLORADO SPRINGS
State : CO
Zip : 80907-6262
Country : US
Telephone Number : 719-636-1201
Fax Number : 719-955-0986
Provider Business Practice Location Address
First Line : 2352 MEADOWS BLVD STE 300
Second Line :
City : CASTLE ROCK
State : CO
Zip : 80109-8419
Country : US
Telephone Number : 720-455-3879
Fax Number : 720-455-3795
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2010
Last Update Date : 07/21/2022

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