Individual
PRAVIN GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
36500 AURORA DR, SUMMIT, WI 53066-4899
(262) 434-1000
(515) 471-9320
Mailing address
36500 AURORA DR, SUMMIT, WI 53066-4899
(262) 434-1000
(515) 471-9320
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01039588
IN
207R00000X
Internal Medicine Physician
40674
IA
207R00000X
Internal Medicine Physician
Primary
9-320
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100072887
—
WI
Enumeration date
08/18/2006
Last updated
07/21/2022
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