Individual
ANJAN GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6847 N CHESTNUT ST STE 100, RAVENNA, OH 44266-3929
(330) 297-6110
(330) 296-0592
Mailing address
PO BOX 2040, MILWAUKEE, WI 53201-2040
(414) 649-3370
(414) 649-3278
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
37401
WI
207RI0011X
Interventional Cardiology Physician
Primary
37401-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32278400
—
WI
Enumeration date
03/16/2006
Last updated
12/22/2020
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