Provider Demographics
NPI:1386775765
Name:DR KAUSHAL K GUPTA MD PA
Entity type:Organization
Organization Name:DR KAUSHAL K GUPTA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAUSHAL
Authorized Official - Middle Name:K
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-447-6334
Mailing Address - Street 1:11206 AIRLINE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77037-1116
Mailing Address - Country:US
Mailing Address - Phone:281-447-6334
Mailing Address - Fax:281-447-8235
Practice Address - Street 1:11206 AIRLINE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77037-1116
Practice Address - Country:US
Practice Address - Phone:281-447-6334
Practice Address - Fax:281-447-8235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8877207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC16393Medicare UPIN
TX00382VMedicare ID - Type UnspecifiedGROUP