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General NPI Number Information
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NPI Number | 1780653154
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Entity Type | Individual
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Provider Name | ANJAN GUPTA MD
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Gender | Male
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Dates
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Enumeration Date | 03/16/2006
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Last Update Date | 12/22/2020
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Provider Practice Location Address
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Address Line | 6847 N CHESTNUT ST STE 100
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City | RAVENNA
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State | OH
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Zip | 44266-3929
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Country | US
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Telephone | 330-297-6110
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Fax | 330-296-0592
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Provider Business Mailing Address
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Address Line | PO BOX 2040
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City | MILWAUKEE
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State | WI
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Zip | 53201-2040
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Country | US
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Telephone | 414-649-3370
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Fax | 414-649-3278
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 37401
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 37401-020
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License Number State | WI
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