Individual
AJAY S GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7956 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 436-2416
(260) 436-9662
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
01037375A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0839507
—
OH
05
—
100258670
—
IN
01
—
130023781
RR MEDICARE
IN
05
—
4596849
—
MI
Enumeration date
06/30/2005
Last updated
10/05/2023
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