Provider Demographics
NPI:1265521470
Name:GUPTA, ASHISH KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:ASHISH
Middle Name:KUMAR
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11616 LAKE UNDERHILL RD
Mailing Address - Street 2:STE 215
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-4465
Mailing Address - Country:US
Mailing Address - Phone:407-482-7788
Mailing Address - Fax:407-482-8698
Practice Address - Street 1:483 N SEMORAN BLVD STE 102
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3800
Practice Address - Country:US
Practice Address - Phone:407-645-1847
Practice Address - Fax:321-274-0246
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2020-12-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME102636207R00000X, 207RC0000X
FLTRN10082207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME102636OtherMEDICAL LICENSE
FL009487500Medicaid
FL009487500Medicaid