Provider Demographics
NPI:1952555666
Name:GUPTA, PRATEEK KUMAR (MBBS)
Entity type:Individual
Prefix:DR
First Name:PRATEEK
Middle Name:KUMAR
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 W BRIERBROOK RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2208
Mailing Address - Country:US
Mailing Address - Phone:901-390-2930
Mailing Address - Fax:901-390-2940
Practice Address - Street 1:1355 W BRIERBROOK RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2208
Practice Address - Country:US
Practice Address - Phone:901-390-2930
Practice Address - Fax:901-390-2940
Is Sole Proprietor?:No
Enumeration Date:2008-11-07
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE115722086S0129X
MS258092086S0129X
TN516772086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ009116Medicaid
MS01303031Medicaid
TN6026580OtherBCBS
AR208461001Medicaid
MS01303031Medicaid