Provider Demographics
NPI:1477105278
Name:AKASH GUPTA MD PC
Entity Type:Organization
Organization Name:AKASH GUPTA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATIVE
Authorized Official - Phone:503-659-1964
Mailing Address - Street 1:6542 SE LAKE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-2245
Mailing Address - Country:US
Mailing Address - Phone:503-659-1964
Mailing Address - Fax:503-659-5022
Practice Address - Street 1:6542 SE LAKE RD STE 201
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-2245
Practice Address - Country:US
Practice Address - Phone:503-659-1964
Practice Address - Fax:503-659-5022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Multi-Specialty