Healthcare Provider Details

I. General information

NPI: 1437314903
Provider Name (Legal Business Name): BHANU PRAKASH GUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 9TH AVE
SEATTLE WA
98101-2756
US

IV. Provider business mailing address

1100 9TH AVE
SEATTLE WA
98101-2756
US

V. Phone/Fax

Practice location:
  • Phone: 206-583-6063
  • Fax: 206-341-1726
Mailing address:
  • Phone: 206-583-6063
  • Fax: 206-341-1726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME123490
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD61393136
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number2013002794
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number04-39156
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License NumberMD61393136
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: