Healthcare Provider Details

I. General information

NPI: 1700643343
Provider Name (Legal Business Name): KAMNA GUPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2024
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 GARDENBROOK CIR APT A
INDIANAPOLIS IN
46202-4662
US

IV. Provider business mailing address

810 GARDENBROOK CIR APT A
INDIANAPOLIS IN
46202-4662
US

V. Phone/Fax

Practice location:
  • Phone: 317-922-9992
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number125.086479
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: