Healthcare Provider Details

I. General information

NPI: 1871597609
Provider Name (Legal Business Name): KUL B GUPTA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 02/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4447 TALMADGE RD STE C
TOLEDO OH
43623-3517
US

IV. Provider business mailing address

4447 TALMADGE RD STE C
TOLEDO OH
43623-3517
US

V. Phone/Fax

Practice location:
  • Phone: 419-475-7007
  • Fax:
Mailing address:
  • Phone: 419-475-7007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35042660
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: