| Ravi Gupta, Md, Pllc | |
|
2075 W Pecos Rd, Ste 2 Chandler AZ 85224-5693 | |
| (480) 219-6840 | |
| (480) 219-6841 |
| Full Name | Ravi Gupta, Md, Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2075 W Pecos Rd,, Chandler, Arizona |
| Authorized Official Name and Position | Ravi Gupta (PRESIDENT) |
| Authorized Official Contact | 4804559616 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ravi Gupta, Md, Pllc 2075 W Pecos Rd Suite 2 Chandler AZ 85224-5722 Ph: (480) 219-6840 | Ravi Gupta, Md, Pllc 2075 W Pecos Rd, Ste 2 Chandler AZ 85224-5693 Ph: (480) 219-6840 |
| NPI Number | 1346487998 |
|---|---|
| Provider Enumeration Date | 01/18/2009 |
| Last Update Date | 11/02/2011 |
| Medicare PECOS PAC ID | 5092870873 |
|---|---|
| Medicare Enrollment ID | O20090210000819 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346487998 | NPI | - | NPPES |
| 1790751949 | Other | NPI PROVIDER | |
| 866965 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 33007 (Arizona) | Primary |
| Provider Name | Ravi Gupta |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1790751949 PECOS PAC ID: 6305817529 Enrollment ID: I20040803000080 |
| Provider Name | Amita Gupta |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962462630 PECOS PAC ID: 4082685201 Enrollment ID: I20040803000124 |
| Provider Name | Anna D Manalo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609205350 PECOS PAC ID: 6305076951 Enrollment ID: I20140228000039 |
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