Provider Demographics
NPI:1083736433
Name:GUPTA, ASHWANI KUMAR (MD MPH)
Entity Type:Individual
Prefix:DR
First Name:ASHWANI
Middle Name:KUMAR
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD MPH
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:14134 NEPHRON LN
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-6504
Mailing Address - Country:US
Mailing Address - Phone:727-863-5418
Mailing Address - Fax:727-869-8626
Practice Address - Street 1:635 4TH ST N
Practice Address - Street 2:STE 200
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-2319
Practice Address - Country:US
Practice Address - Phone:727-201-4968
Practice Address - Fax:727-201-4971
Is Sole Proprietor?:No
Enumeration Date:2007-04-05
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085675207R00000X
FLME107040207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0023651-00Medicaid
FLDK013ZMedicare PIN