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General NPI Number Information
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NPI Number | 1851514509
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Entity Type | Individual
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Provider Name | RAJENDRA GUPTA M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10257 STATE ROUTE 3
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City | RED BUD
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State | IL
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Zip | 62278-4418
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Country | US
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Telephone | 618-282-6233
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Fax | 618-282-6949
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Provider Business Mailing Address
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Address Line | 13217 DUNROYAL DR
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City | SAINT LOUIS
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State | MO
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Zip | 63131-1919
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Country | US
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Telephone | 314-965-4579
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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 | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number |
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License Number State | IL
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