MEDICARE: RAVI KUMAR 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	207Q00000X	Family Medicine Physician	S3984	TX
2	207Q00000X	Family Medicine Physician	327881	LA

General Provider Information

NPI Number	:	1437600624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAVI KUMAR GUPTA MD

Provider Business Mailing Address
First Line	:	4700 MILLENIA BLVD STE 650
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-6013
Country	:	US
Telephone Number	:	407-533-6836
Fax Number	:	407-232-9316

Provider Business Practice Location Address
First Line	:	725 W PIONEER PKWY
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75051-4849
Country	:	US
Telephone Number	:	945-899-0770
Fax Number	:	877-694-3502

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

Provider Enumeration Date	:	10/22/2016
Last Update Date	:	03/17/2026

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