Provider Demographics
NPI:1245232958
Name:GUPTA, ARUN K (MD)
Entity Type:Individual
Prefix:
First Name:ARUN
Middle Name:K
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 1:20050 HARVARD AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-6816
Mailing Address - Country:US
Mailing Address - Phone:216-283-0750
Mailing Address - Fax:216-491-6374
Practice Address - Street 1:20050 HARVARD AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-6816
Practice Address - Country:US
Practice Address - Phone:216-283-0750
Practice Address - Fax:216-491-6374
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH59612207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0785664Medicaid
OH110073488OtherRAILROAD MEDICARE
OH0785664Medicaid