Provider Demographics
NPI:1912313263
Name:GUPTA, KARANVIR (MD)
Entity type:Individual
Prefix:
First Name:KARANVIR
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 1:283 N PECOS RD STE 120
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-1918
Mailing Address - Country:US
Mailing Address - Phone:702-357-5814
Mailing Address - Fax:886-739-9251
Practice Address - Street 1:283 N PECOS RD STE 120
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-1918
Practice Address - Country:US
Practice Address - Phone:702-357-5814
Practice Address - Fax:886-739-9251
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2024-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRL13320207Q00000X
NV17418207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV17418OtherSTATE LICENSE
NV1912313263Medicaid