Healthcare Provider Details

I. General information

NPI: 1700145422
Provider Name (Legal Business Name): MADHURI GUPTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADHURI MURTHY

II. Dates (important events)

Enumeration Date: 05/15/2012
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 NORTH AVE
BATTLE CREEK MI
49017-3307
US

IV. Provider business mailing address

255 W MICHIGAN AVENUE PO BOX 1123
JACKSON MI
49201-2218
US

V. Phone/Fax

Practice location:
  • Phone: 269-245-3321
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number20312091126
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number20312091126
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: