MEDICARE: SANDEEP GUPTA MD LLC

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	2084P0800X	Psychiatry Physician	35.122881	OH

General Provider Information

NPI Number	:	1245650001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANDEEP GUPTA MD LLC

Provider Business Mailing Address
First Line	:	2450 UNDERHILL RD
Second Line	:
City	:	OTTAWA HILLS
State	:	OH
Zip	:	43615-2332
Country	:	US
Telephone Number	:	419-290-3672
Fax Number	:

Provider Business Practice Location Address
First Line	:	2450 UNDERHILL RD
Second Line	:
City	:	OTTAWA HILLS
State	:	OH
Zip	:	43615-2332
Country	:	US
Telephone Number	:	419-290-3672
Fax Number	:

Authorized Official
Title or Position	:	PSYCHIATRIST
Name	:	SANDEEP GUPTA
Credential	:	M.D.
Telephone Number	:	419-290-3672

Provider Enumeration Date	:	04/21/2014
Last Update Date	:	04/21/2014

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