Healthcare Provider Details

I. General information

NPI: 1295716686
Provider Name (Legal Business Name): RAKESH GUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 01/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 HOSPITAL DRIVE SUITE 340
BATAVIA OH
45103
US

IV. Provider business mailing address

2055 HOSPITAL DRIVE SUITE 340
BATAVIA OH
45103
US

V. Phone/Fax

Practice location:
  • Phone: 513-735-7872
  • Fax: 513-732-8602
Mailing address:
  • Phone: 513-735-7872
  • Fax: 513-732-8602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35.044322
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: