Healthcare Provider Details

I. General information

NPI: 1730183401
Provider Name (Legal Business Name): SHAMINDER MOHAN GUPTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 10/11/2026
Certification Date: 10/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 WESTFORK DR STE 401
BATON ROUGE LA
70827-0004
US

IV. Provider business mailing address

5410 MARYLAND WAY STE 400
BRENTWOOD TN
37027-8087
US

V. Phone/Fax

Practice location:
  • Phone: 855-212-2273
  • Fax:
Mailing address:
  • Phone: 855-212-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number24216
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME147819
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number27111
License Number StateMS
# 4
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number024216
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number87357
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: