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NPI Code Detail

MEDICARE: SHABNUM GUPTA MD

MEDICARE: SHABNUM 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
1207Q00000XFamily Medicine Physician17487ND
2207Q00000XFamily Medicine PhysicianRL15079ND

General Provider Information

NPI Number : 1710472725
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHABNUM GUPTA MD
Provider Business Mailing Address
First Line : PO BOX 5074
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57117-5074
Country : US
Telephone Number : 605-328-6585
Fax Number : 605-312-9802
Provider Business Practice Location Address
First Line : 2400 32ND AVE S
Second Line :
City : FARGO
State : ND
Zip : 58103-5800
Country : US
Telephone Number : 701-234-2000
Fax Number : 701-234-8803
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2018
Last Update Date : 04/19/2026

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