Healthcare Provider Details

I. General information

NPI: 1275708380
Provider Name (Legal Business Name): ASHOK K GUPTA MD PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E SPICERVILLE HWY
EATON RAPIDS MI
48827-1919
US

IV. Provider business mailing address

101 E SPICERVILLE HWY
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 TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number4301048680
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301048680
License Number StateMI

VIII. Authorized Official

Name: MRS. JULIE A HANNON
Title or Position: FINANCIAL DIRECTOR
Credential:
Phone: 517-663-9469