Provider Demographics
NPI:1003032111
Name:GUPTA, VIKAS (MD)
Entity Type:Individual
Prefix:DR
First Name:VIKAS
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 947407
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30394-7407
Mailing Address - Country:US
Mailing Address - Phone:941-917-2600
Mailing Address - Fax:941-917-7884
Practice Address - Street 1:1921 WALDEMERE ST STE 607
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2913
Practice Address - Country:US
Practice Address - Phone:941-262-3100
Practice Address - Fax:941-261-3760
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS3985207T00000X, 2084A2900X, 2084V0102X
MI4301087270207R00000X
FLME128249207T00000X, 2084V0102X
MO20130034752084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2084A2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurocritical Care
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology