Healthcare Provider Details

I. General information

NPI: 1457406423
Provider Name (Legal Business Name): SANDEEP GUPTA, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8220 WALNUT HILL LN SUITE 101
DALLAS TX
75231-4427
US

IV. Provider business mailing address

8220 WALNUT HILL LN SUITE 101
DALLAS TX
75231-4427
US

V. Phone/Fax

Practice location:
  • Phone: 214-369-1901
  • Fax: 214-369-1905
Mailing address:
  • Phone: 214-369-1901
  • Fax: 214-369-1905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberL8357
License Number StateTX

VIII. Authorized Official

Name: SANDEEP GUPTA
Title or Position: DIRECTOR
Credential: M.D.
Phone: 214-369-1901