Provider Demographics
NPI:1972721835
Name:GUPTA, HIMESH (MD)
Entity Type:Individual
Prefix:DR
First Name:HIMESH
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 1:4744 WE ROSS PKWY
Mailing Address - Street 2:32-106
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-7169
Mailing Address - Country:US
Mailing Address - Phone:662-342-4091
Mailing Address - Fax:
Practice Address - Street 1:UT COLLEGE OF MEDICINE
Practice Address - Street 2:920 MADISON AVENUE, SUITE C 50
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105
Practice Address - Country:US
Practice Address - Phone:901-287-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program