Provider Demographics
NPI:1255442067
Name:GUPTA, INDU RANI (MD)
Entity type:Individual
Prefix:
First Name:INDU
Middle Name:RANI
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 1:2000 SHALLOW STREAM CV
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-1737
Mailing Address - Country:US
Mailing Address - Phone:615-579-0338
Mailing Address - Fax:
Practice Address - Street 1:2000 SHALLOW STREAM CV
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-1737
Practice Address - Country:US
Practice Address - Phone:615-579-0338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3219208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX048039403Medicaid
TX048039403Medicaid