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Individual

DR. AJAY K GUPTA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
3113 SAEMANN AVE, SHEBOYGAN, WI 53081-1957
(920) 496-4700
Mailing address
3113 SAEMANN AVE, SHEBOYGAN, WI 53081-1957
(920) 496-4700

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
71682-20
WI
207W00000X
Ophthalmology Physician
OH 35 084276
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000358460
ANTHEM BCBS
OH
05
100095643
WI
05
2551662
OH
Enumeration date
09/02/2006
Last updated
04/22/2024
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