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General NPI Number Information
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NPI Number | 1285704494
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Entity Type | Individual
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Provider Name | RAKESH KUMAR GUPTA MD
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Gender | Male
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 07/23/2007
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Provider Practice Location Address
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Address Line | 1501 WABASH ST STE 303
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City | MICHIGAN CITY
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State | IN
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Zip | 46360
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Country | US
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Telephone | 219-874-8711
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Fax |
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Provider Business Mailing Address
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Address Line | 1501 WABASH ST SUITE 303
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City | MICHIGAN CITY
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State | IN
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Zip | 46360-4360
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Country | US
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Telephone |
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Fax |
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 01029292
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License Number State | IN
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