Healthcare Provider Details

I. General information

NPI: 1093014771
Provider Name (Legal Business Name): AKASH GUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6542 SE LAKE RD STE 201
MILWAUKIE OR
97222-2245
US

IV. Provider business mailing address

2128 SE 50TH AVE
PORTLAND OR
97215-3825
US

V. Phone/Fax

Practice location:
  • Phone: 503-659-1769
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberMD183085
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: