Provider Demographics
NPI:1770687386
Name:GUPTA, MANISH K (MD)
Entity Type:Individual
Prefix:
First Name:MANISH
Middle Name:K
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6280 W SAMPLE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-3173
Mailing Address - Country:US
Mailing Address - Phone:561-314-7200
Mailing Address - Fax:561-314-7201
Practice Address - Street 1:9325 GLADES RD
Practice Address - Street 2:SUITE 205
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-3988
Practice Address - Country:US
Practice Address - Phone:561-314-7200
Practice Address - Fax:561-314-7201
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2014-11-03
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Provider Licenses
StateLicense IDTaxonomies
FLME95180207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276463600Medicaid
FL56513OtherBCBS
FL56513OtherBCBS
FLAA209ZMedicare PIN