Provider Demographics
NPI:1811275415
Name:GUPTA, RAJIB KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:RAJIB KUMAR
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:DEPT OF PATHOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-3666
Mailing Address - Fax:414-805-6980
Practice Address - Street 1:2315 STOCKTON BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2201
Practice Address - Country:US
Practice Address - Phone:916-734-5069
Practice Address - Fax:916-734-0299
Is Sole Proprietor?:No
Enumeration Date:2011-07-30
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC187966207ZP0102X
WI65750207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1811275415Medicaid