MEDICARE: DR. ASHOK GUPTA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	4301042770	MI

General Provider Information

NPI Number	:	1285788463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASHOK GUPTA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 645
Second Line	:
City	:	KEEGO HARBOR
State	:	MI
Zip	:	48320-0645
Country	:	US
Telephone Number	:	248-681-6577
Fax Number	:	248-732-7136

Provider Business Practice Location Address
First Line	:	2111 ORCHARD LAKE RD
Second Line	:
City	:	SYLVAN LAKE
State	:	MI
Zip	:	48320-1785
Country	:	US
Telephone Number	:	248-681-6577
Fax Number	:	248-732-7136

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	03/25/2013

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