1235189085 NPI number — SHIKHA GUPTA MD

Table of content: SHIKHA GUPTA MD (NPI 1235189085)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235189085 NPI number — SHIKHA GUPTA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUPTA
Provider First Name:
SHIKHA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KHULLAR
Provider Other First Name:
SHIKHA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235189085
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 40480
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36640-0480
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-471-7150
Provider Business Mailing Address Fax Number:
251-471-7008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2451 FILLINGIM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36617-2238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-471-7150
Provider Business Practice Location Address Fax Number:
251-471-7008
Provider Enumeration Date:
05/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  26632 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 009911162 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009911161 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009936027 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051533399 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51542494 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51542857 . This is a "BCBS - STANTON RD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009936024 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051533403 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51542495 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009911163 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009936023 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009936026 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051533401 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051533402 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 279730500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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