Provider Demographics
NPI:1891772778
Name:GUPTA, NISHEETH (MD)
Entity type:Individual
Prefix:DR
First Name:NISHEETH
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E 89TH AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7319
Mailing Address - Country:US
Mailing Address - Phone:219-736-2800
Mailing Address - Fax:219-736-6680
Practice Address - Street 1:929 RIDGE RD
Practice Address - Street 2:SUITE 5
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1751
Practice Address - Country:US
Practice Address - Phone:219-836-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042940207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000085037OtherINDIANA CARPENTERS
IN100464750Medicaid
100464750AOtherMOLINA
IN000000085037OtherANTHEM
N254509OtherHARMONY HEALTH
254509OtherWELLCARE
9220968OtherADVOCATE PHO
830002223OtherTRAVELERS MEDICARE
000000085037OtherUNICARE
830002223OtherTRAVELERS MEDICARE