Healthcare Provider Details

I. General information

NPI: 1235391418
Provider Name (Legal Business Name): INDRANIL SEN-GUPTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: NEIL SEN GUPTA

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9811 W CHARLESTON BLVD STE 2-641
LAS VEGAS NV
89117-7528
US

IV. Provider business mailing address

4500 ELDORADO PKWY STE 3400
MCKINNEY TX
75070-2760
US

V. Phone/Fax

Practice location:
  • Phone: 855-864-4322
  • Fax: 866-540-2867
Mailing address:
  • Phone: 855-864-4322
  • Fax: 866-540-2867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA119381
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number125054186
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number23149
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberTM-2023-0312
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number208784
License Number StateAK
# 6
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberMD216692
License Number StateOR
# 7
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberME164345
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberMD23244
License Number StateHI
# 9
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number1014932
License Number StateMA
# 10
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number89741
License Number StateSC
# 11
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberU6075
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: