Healthcare Provider Details

I. General information

NPI: 1265521470
Provider Name (Legal Business Name): ASHISH KUMAR GUPTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 12/16/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

483 N SEMORAN BLVD STE 102
WINTER PARK FL
32792-3800
US

IV. Provider business mailing address

11616 LAKE UNDERHILL RD STE 215
ORLANDO FL
32825-4465
US

V. Phone/Fax

Practice location:
  • Phone: 407-645-1847
  • Fax: 321-274-0246
Mailing address:
  • Phone: 407-482-7788
  • Fax: 407-482-8698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME102636
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberTRN10082
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME102636
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: