Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 82595 | OH |
N | 2080P0214X | Pediatric Pulmonologist | 82595 | OH |
NPI | 1578500252 |
---|---|
Provider Name | Sameer Gupta |
First Address | Minneapolis, MN 55455 |
Second Address | Minneapolis, MN 55455 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 31/05/2012 |