Healthcare Provider Details

I. General information

NPI: 1114993680
Provider Name (Legal Business Name): ASHUTOSH GUPTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 10/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 S. CLIFF AVE STE 010
SIOUX FALLS SD
57105-1014
US

IV. Provider business mailing address

PO BOX 86370
SIOUX FALLS SD
57118-6370
US

V. Phone/Fax

Practice location:
  • Phone: 605-322-3666
  • Fax: 605-322-3665
Mailing address:
  • Phone: 605-322-7510
  • Fax: 605-322-6475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number5374
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: