Healthcare Provider Details

I. General information

NPI: 1457647646
Provider Name (Legal Business Name): NITIN KUMAR GUPTA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2011
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9362 TEDDY LN STE 105
LONE TREE CO
80124-2871
US

IV. Provider business mailing address

9362 TEDDY LN STE 105
LONE TREE CO
80124-2871
US

V. Phone/Fax

Practice location:
  • Phone: 515-865-1568
  • Fax:
Mailing address:
  • Phone: 720-373-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDR.0058333
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberDR.0058333
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberDR.0058333
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: