Doctor Name: | CHERYL GUPTA |
NPI Number: | 1013182815 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | DO |
License Number: | |
Business Practice Address: | 3820 W Bluemound Rd, Suite 125 Wauwatosa, WI - 53213 |
Business Phone Number: | 4143023800 |
Business Fax Number: | 4143023813 |
Mailing Address: | 1211 Marina Dr, GRAFTON |
State: | WI |
Postal Code: | 530249334 |
Phone Number: | 4143757867 |
Fax Number: | |
NPI Enumeration Date: | 04/23/2008 |
NPI Last Update Date: | 04/26/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |