Individual
AMIT GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2845 GREENBRIER RD, GREEN BAY, WI 54311-6519
(920) 288-5656
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
69240
WI
207QS1201X
Sleep Medicine (Family Medicine) Physician
69240
WI
207RS0012X
Sleep Medicine (Internal Medicine) Physician
Primary
69240
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100079506
—
WI
Enumeration date
04/01/2014
Last updated
10/31/2023
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