Provider Demographics
NPI:1013182815
Name:GUPTA, CHERYL (DO)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:
Other - Last Name:HARPENAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1211 MARINA DR
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-9334
Mailing Address - Country:US
Mailing Address - Phone:414-375-7867
Mailing Address - Fax:
Practice Address - Street 1:3820 W BLUEMOUND RD, SUITE 125
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213
Practice Address - Country:US
Practice Address - Phone:414-302-3800
Practice Address - Fax:414-302-3813
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI54224207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program