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General NPI Number Information
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NPI Number | 1124005863
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Entity Type | Individual
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Provider Name | MANISH R GUPTA DO
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Gender | Male
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Dates
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Enumeration Date | 12/23/2005
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Last Update Date | 02/06/2015
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Provider Practice Location Address
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Address Line | 1050 ISAAC STREETS DR SUITE 136
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City | OREGON
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State | OH
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Zip | 43616-3291
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Country | US
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Telephone | 419-696-5656
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Fax | 419-844-8784
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Provider Business Mailing Address
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Address Line | 1050 ISAAC STREETS DR SUITE 136
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City | OREGON
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State | OH
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Zip | 43616-3291
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Country | US
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Telephone | 419-696-5656
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Fax | 419-844-8784
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 35-07-6763-G
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License Number State | OH
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