Individual
SHELLY GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2900 W OKLAHOMA AVE, MILWAUKEE, WI 53215-4330
(414) 649-6000
(414) 649-5296
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
65095-20
WI
208M00000X
Hospitalist Physician
Primary
65095
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100060733
—
WI
Enumeration date
07/16/2013
Last updated
01/28/2025
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