Healthcare Provider Details

I. General information

NPI: 1467009035
Provider Name (Legal Business Name): ANU GUPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 08/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 W MONROE ST
JACKSON MI
49202-2079
US

IV. Provider business mailing address

4065 SUMMERFIELD DR
TROY MI
48085-7034
US

V. Phone/Fax

Practice location:
  • Phone: 248-408-7927
  • Fax:
Mailing address:
  • Phone: 512-740-0156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: