MEDICARE: DR. AMIT KUMAR GUPTA MD

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	208M00000X	Hospitalist Physician	036.130384	IL
2	207RI0011X	Interventional Cardiology Physician	ME136345	FL
3	207R00000X	Internal Medicine Physician	BP10034481	TX
4	207RI0011X	Interventional Cardiology Physician	BP10059228	TX

General Provider Information

NPI Number	:	1114252475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMIT KUMAR GUPTA MD

Provider Business Mailing Address
First Line	:	101 RIVERFRONT BLVD STE 710
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34205-8812
Country	:	US
Telephone Number	:	941-776-4000
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 RIVERSIDE DR E STE 2010
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34208-1023
Country	:	US
Telephone Number	:	941-405-1170
Fax Number	:

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

Provider Enumeration Date	:	10/05/2009
Last Update Date	:	10/30/2023

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