Healthcare Provider Details

I. General information

NPI: 1427580893
Provider Name (Legal Business Name): KAPIL GUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4216 S UNIVERSITY DR
DAVIE FL
33328-3007
US

IV. Provider business mailing address

4216 S UNIVERSITY DR
DAVIE FL
33328-3007
US

V. Phone/Fax

Practice location:
  • Phone: 954-742-0112
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number142090
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number142090
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: