Healthcare Provider Details

I. General information

NPI: 1952555666
Provider Name (Legal Business Name): PRATEEK KUMAR GUPTA MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2008
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 W BRIERBROOK RD
GERMANTOWN TN
38138-2208
US

IV. Provider business mailing address

1375 W BRIERBROOK RD
GERMANTOWN TN
38138-2208
US

V. Phone/Fax

Practice location:
  • Phone: 901-390-2930
  • Fax: 901-390-2940
Mailing address:
  • Phone: 901-390-2930
  • Fax: 901-390-2940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberE11572
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number25809
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number51677
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: