MEDICARE: DR. RUPAL PATEL GUPTA DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	POD000958	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	52026903	OTHER	GA	BCBS
2	260427	OTHER	GA	COVENTRY
3	7540578	OTHER	GA	AETNA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	5363600001	OTHER	GA	CIGNA DME
6	226592810	OTHER	GA	UHC
7	7305891	OTHER	GA	CIGNA

General Provider Information

NPI Number	:	1003810623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUPAL PATEL GUPTA DPM

Provider Business Mailing Address
First Line	:	3995 MONTGLENN TRCE
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30041-7373
Country	:	US
Telephone Number	:	770-418-0456
Fax Number	:	770-418-1603

Provider Business Practice Location Address
First Line	:	4355 JOHNS CREEK PKWY
Second Line	:	SUITE 520
City	:	SUWANEE
State	:	GA
Zip	:	30024-6048
Country	:	US
Telephone Number	:	770-418-0456
Fax Number	:	770-418-1603

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	12/30/2010

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Directions to “ DR. RUPAL PATEL GUPTA DPM” Practice Location

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