MEDICARE: RAKESH K 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	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568443141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAKESH K GUPTA MD

Provider Business Mailing Address
First Line	:	1324 STATE ROUTE 125
Second Line	:	SUITE 101
City	:	AMELIA
State	:	OH
Zip	:	45102-0015
Country	:	US
Telephone Number	:	513-752-0004
Fax Number	:	513-752-0731

Provider Business Practice Location Address
First Line	:	1324 STATE ROUTE 125
Second Line	:	SUITE 101
City	:	AMELIA
State	:	OH
Zip	:	45102-0015
Country	:	US
Telephone Number	:	513-752-0004
Fax Number	:	513-752-0731

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RAKESH K GUPTA
Credential	:	MD
Telephone Number	:	513-752-0004

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	10/12/2011

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