Provider Demographics
NPI:1952341968
Name:GUPTA, LALIT (MD)
Entity Type:Individual
Prefix:
First Name:LALIT
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 1:1836 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-5429
Mailing Address - Country:US
Mailing Address - Phone:608-782-7300
Mailing Address - Fax:
Practice Address - Street 1:1830 STATE HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-7301
Practice Address - Country:US
Practice Address - Phone:563-382-3140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN433992084P0800X
WI582392084P0800X
IA398022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND22366OtherNORTH DAKOTA BLUE SHIELD
MN151723OtherUCARE MINNESOTA
MN228635100Medicaid
MN1032367OtherPREFERREDONE
MN15-50124OtherUNITED BEHAVIORAL HEALTH
MN388S8GUOtherBLUE SHIELD OF MN
FMHP36635OtherHEALTHPARTNERS
ND22366OtherNORTH DAKOTA BLUE SHIELD
MN151723OtherUCARE MINNESOTA