Basic Information
| Provider Information | |||||||||
| NPI: | 1093489718 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUPTA | ||||||||
| FirstName: | VIKAS | ||||||||
| MiddleName: | ANAND | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 11TH AVE SW | ||||||||
| Address2: | |||||||||
| City: | MINOT | ||||||||
| State: | ND | ||||||||
| PostalCode: | 587014207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7018586778 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1201 11TH AVE SW | ||||||||
| Address2: | |||||||||
| City: | MINOT | ||||||||
| State: | ND | ||||||||
| PostalCode: | 587014207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7018586778 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2021 | ||||||||
| LastUpdateDate: | 08/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | RL17346 | ND | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.