Individual
VICRAM GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
902 N RIVERSIDE RD, STE 200, ST JOSEPH, MO 64507-2559
(816) 271-1301
(816) 271-1302
Mailing address
902 N RIVERSIDE RD, STE 200, ST JOSEPH, MO 64507-2559
(816) 271-1301
(816) 271-1302
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
0427852
KS
207RX0202X
Medical Oncology Physician
Primary
107588
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
056938
BCBS OF KS FOR KS LOCATIO
KS
05
—
100173870C
—
KS
05
—
1629046420
—
MO
01
—
21958014
BLUE CROSS BLUE SHIELD
MO
01
—
704173
BCBS OF KS FOR MO LOCATIO
KS
01
—
P00859658
RR MEDICARE
MO
Enumeration date
03/09/2006
Last updated
10/19/2017
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