Individual
ACHAL GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1120 PINE ST, STANLEY, WI 54768-1297
(715) 644-5530
Mailing address
3021 VOYAGER DR, GREEN BAY, WI 54311-8303
(715) 644-5530
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
54799-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
54799
WI MEDICAL LICENSE
WI
Enumeration date
05/29/2009
Last updated
08/20/2018
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