Healthcare Provider Details

I. General information

NPI: 1144288663
Provider Name (Legal Business Name): PADMA GUPTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13500 SW 88TH ST SUITE 181
MIAMI FL
33186-1515
US

IV. Provider business mailing address

13500 SW 88TH ST SUITE 181
MIAMI FL
33186-1515
US

V. Phone/Fax

Practice location:
  • Phone: 305-752-2600
  • Fax: 305-752-2829
Mailing address:
  • Phone: 305-752-2600
  • Fax: 305-752-2829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0031109
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: