Healthcare Provider Details

I. General information

NPI: 1306469598
Provider Name (Legal Business Name): ROHIT GUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date: 01/18/2022
Reactivation Date: 02/08/2022

III. Provider practice location address

ONE HURLEY PLAZA
FLINT MI
48503
US

IV. Provider business mailing address

1 HURLEY PLAZA, HURLEY MEDICAL CENTER PEDIATRIC EDUCATION 6 W
FLINT MI
48503
US

V. Phone/Fax

Practice location:
  • Phone: 810-262-9000
  • Fax:
Mailing address:
  • Phone: 810-262-9000
  • Fax: 810-262-9736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4351046260
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: