Provider Demographics
NPI:1235189085
Name:GUPTA, SHIKHA (MD)
Entity Type:Individual
Prefix:
First Name:SHIKHA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHIKHA
Other - Middle Name:
Other - Last Name:KHULLAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-471-7150
Mailing Address - Fax:251-471-7008
Practice Address - Street 1:2451 FILLINGIM ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617-2238
Practice Address - Country:US
Practice Address - Phone:251-471-7150
Practice Address - Fax:251-471-7008
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL266322085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009911162Medicaid
AL009911161Medicaid
AL009936027Medicaid
AL051533399OtherBLUE CROSS
AL51542494OtherBCBS
AL51542857OtherBCBS - STANTON RD
AL009936024Medicaid
AL051533403OtherBLUE CROSS
AL51542495OtherBCBS
AL009911163Medicaid
AL009936023Medicaid
AL009936026Medicaid
AL051533401OtherBLUE CROSS
AL051533402OtherBLUE CROSS
AL51542857OtherBCBS - STANTON RD
AL009911163Medicaid