Provider Demographics
NPI:1578726477
Name:GUPTA, SHUBHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:SHUBHAM
Middle Name:
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 1:11100 EUCLID AVE STE 4554
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1716
Mailing Address - Country:US
Mailing Address - Phone:216-285-5036
Mailing Address - Fax:859-323-1944
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:MS235
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-218-5771
Practice Address - Fax:859-323-1944
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS709--L208600000X
KY47046208800000X, 2088F0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088F0040XAllopathic & Osteopathic PhysiciansUrologyFemale Pelvic Medicine and Reconstructive Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No208800000XAllopathic & Osteopathic PhysiciansUrology