Healthcare Provider Details

I. General information

NPI: 1982664207
Provider Name (Legal Business Name): ARJUN K GUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2031 ROOSEVELT RD
VALPARAISO IN
46383-2746
US

IV. Provider business mailing address

2031 ROOSEVELT RD
VALPARAISO IN
46383-2746
US

V. Phone/Fax

Practice location:
  • Phone: 219-736-8117
  • Fax: 219-464-7651
Mailing address:
  • Phone: 219-736-8117
  • Fax: 219-464-7651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberIN01030993B
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: