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General NPI Number Information
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NPI Number | 1124132188
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Entity Type | Individual
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Provider Name | PRAVIN GUPTA M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 36500 AURORA DR
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City | SUMMIT
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State | WI
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Zip | 53066-4899
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Country | US
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Telephone | 262-434-1000
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Fax | 515-471-9320
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Provider Business Mailing Address
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Address Line | 36500 AURORA DR
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City | SUMMIT
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State | WI
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Zip | 53066-4899
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Country | US
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Telephone | 262-434-1000
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Fax | 515-471-9320
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 01039588
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 40674
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 9-320
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License Number State | WI
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