Provider Demographics
NPI:1659378917
Name:GUPTA, NAVIN KUMAR (DPM)
Entity Type:Individual
Prefix:DR
First Name:NAVIN
Middle Name:KUMAR
Last Name:GUPTA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 S 68TH ST STE 1208
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8176
Mailing Address - Country:US
Mailing Address - Phone:515-226-2189
Mailing Address - Fax:515-226-2199
Practice Address - Street 1:230 S 68TH ST STE 1208
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8176
Practice Address - Country:US
Practice Address - Phone:515-226-2189
Practice Address - Fax:515-226-2199
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00508213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1009688Medicaid
IA00968OtherBC/BS OF IA
IA2009688Medicaid
U20647Medicare UPIN
IA00968Medicare PIN
IA5925070001Medicare NSC