Healthcare Provider Details

I. General information

NPI: 1023104445
Provider Name (Legal Business Name): MAYANK GUPTA MD (MBBS)
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10995 QUIVIRA RD
OVERLAND PARK KS
66210
US

IV. Provider business mailing address

10995 QUIVIRA RD
OVERLAND PARK KS
66210-1207
US

V. Phone/Fax

Practice location:
  • Phone: 913-339-9437
  • Fax: 913-339-9538
Mailing address:
  • Phone: 913-339-9437
  • Fax: 913-339-9538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number2011008002
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number04-34978
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: