Provider Demographics
NPI:1568443141
Name:RAKESH K GUPTA MD
Entity Type:Organization
Organization Name:RAKESH K GUPTA MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAKESH
Authorized Official - Middle Name:K
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-752-0004
Mailing Address - Street 1:1324 STATE ROUTE 125
Mailing Address - Street 2:SUITE 101
Mailing Address - City:AMELIA
Mailing Address - State:OH
Mailing Address - Zip Code:45102-0015
Mailing Address - Country:US
Mailing Address - Phone:513-752-0004
Mailing Address - Fax:513-752-0731
Practice Address - Street 1:1324 STATE ROUTE 125
Practice Address - Street 2:SUITE 101
Practice Address - City:AMELIA
Practice Address - State:OH
Practice Address - Zip Code:45102-0015
Practice Address - Country:US
Practice Address - Phone:513-752-0004
Practice Address - Fax:513-752-0731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0418775Medicaid
OH9293821Medicare PIN