Healthcare Provider Details

I. General information

NPI: 1114980075
Provider Name (Legal Business Name): BHARAT KUMAR GUPTA M.D., FACP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 E OAKLAND PARK BLVD
OAKLAND PARK FL
33334-2725
US

IV. Provider business mailing address

911 E OAKLAND PARK BLVD
OAKLAND PARK FL
33334-2725
US

V. Phone/Fax

Practice location:
  • Phone: 954-727-2300
  • Fax: 954-727-2301
Mailing address:
  • Phone: 954-727-2300
  • Fax: 954-727-2301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME75767
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: