Healthcare Provider Details

I. General information

NPI: 1841299138
Provider Name (Legal Business Name): ANAND GUPTA MD, FACG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 08/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003N DUPONT SQ 9A
LOUISVILLE KY
40207
US

IV. Provider business mailing address

1003 N DUPONT SQ 9 A
LOUISVILLE KY
40207-4612
US

V. Phone/Fax

Practice location:
  • Phone: 502-893-7744
  • Fax: 502-893-7741
Mailing address:
  • Phone: 502-893-7744
  • Fax: 502-893-7741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number33458
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: