MEDICARE: GUPTA HEADACHE & PAIN INSTITUTE, P.A.

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	2084P2900X	Pain Medicine (Psychiatry & Neurology) Physician	K0794	TX

General Provider Information

NPI Number	:	1013014224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUPTA HEADACHE & PAIN INSTITUTE, P.A.

Provider Business Mailing Address
First Line	:	4407 BEE CAVE RD
Second Line	:	SUITE 211
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-6405
Country	:	US
Telephone Number	:	512-330-0961
Fax Number	:	512-330-0962

Provider Business Practice Location Address
First Line	:	4407 BEE CAVE RD
Second Line	:	SUITE 211
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-6405
Country	:	US
Telephone Number	:	512-330-0961
Fax Number	:	512-330-0962

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RAJAT GUPTA
Credential	:	M.D.
Telephone Number	:	512-330-0961

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	06/24/2020

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