Healthcare Provider Details

I. General information

NPI: 1003886565
Provider Name (Legal Business Name): ASHOK K GUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 10/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E SPICERVILLE HWY STE 300
EATON RAPIDS MI
48827-1919
US

IV. Provider business mailing address

101 E SPICERVILLE HWY PO BOX 521
EATON RAPIDS MI
48827-1919
US

V. Phone/Fax

Practice location:
  • Phone: 517-663-9469
  • Fax: 517-663-9470
Mailing address:
  • Phone: 517-663-9469
  • Fax: 517-663-9470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberAG048680
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: