Provider Demographics
NPI:1114993680
Name:GUPTA, ASHUTOSH (MD)
Entity Type:Individual
Prefix:
First Name:ASHUTOSH
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 86370
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6370
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:1417 S. CLIFF AVE
Practice Address - Street 2:STE 010
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1014
Practice Address - Country:US
Practice Address - Phone:605-322-3666
Practice Address - Fax:605-322-3665
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD53742080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD2277812OtherARAZ/ AMERICA'S PPO
SD370624200OtherDEPT OF LABOR
MN486T4GUOtherCC SYSTEMS/ BLUE PLUS
SD722801041579OtherPREFERRED ONE
MN000080878OtherPRIMEWEST
SD243254OtherMIDLANDS CHOICE
SD4995353OtherBLUE CROSS
SD57105I009OtherWPS TRICARE
SDHP43044OtherHEALTHPARTNERS
SD6004860Medicaid
ND13414Medicaid
SD5374OtherDAKOTACARE
IA0581785Medicaid
MN486T4GUOtherBLUE CROSS
SD1202972OtherMEDICA
SD36795OtherSANFORD HEALTH PLAN
MN684477400Medicaid
NE46022474339Medicaid
SD2277812OtherARAZ/ AMERICA'S PPO
SDS42061Medicare PIN