Provider Demographics
NPI:1376621896
Name:GUPTA, KUL B (MD)
Entity Type:Individual
Prefix:DR
First Name:KUL
Middle Name:B
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KUL
Other - Middle Name:BHUSHAN
Other - Last Name:GUPTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5410 MARYLAND WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5064
Mailing Address - Country:US
Mailing Address - Phone:615-377-5667
Mailing Address - Fax:888-241-1404
Practice Address - Street 1:3001 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6307
Practice Address - Country:US
Practice Address - Phone:813-870-4933
Practice Address - Fax:817-870-4887
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43554207R00000X
FLME103161207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34227400Medicaid
FL1458FOtherBCBS OF FLORIDA
FL001056600Medicaid
WI34227400Medicaid
H72647Medicare UPIN
02120-0165Medicare ID - Type UnspecifiedMEDICARE PROVIDER