Provider Demographics
NPI:1134170848
Name:GUPTA, DEBRA L (MD)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:L
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5250 W 94TH TERRACE
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66207-2502
Mailing Address - Country:US
Mailing Address - Phone:913-451-0000
Mailing Address - Fax:913-491-0547
Practice Address - Street 1:5250 W 94TH TERRACE
Practice Address - Street 2:
Practice Address - City:PAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66207-2502
Practice Address - Country:US
Practice Address - Phone:913-780-0030
Practice Address - Fax:913-782-2924
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0424531207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100152300BMedicaid
KS0338024DMedicare ID - Type Unspecified
KS100152300BMedicaid