Healthcare Provider Details

I. General information

NPI: 1891757100
Provider Name (Legal Business Name): SUBHASH C GUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E MICHIGAN AVE LOWER LEVEL
LANSING MI
48912-1800
US

IV. Provider business mailing address

1540 LAKE LANSING RD SUITE G06
LANSING MI
48912-3756
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-5330
  • Fax: 517-364-5335
Mailing address:
  • Phone: 517-482-7246
  • Fax: 517-484-7377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4301056151
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number4301056151
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number4301056151
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number4301056151
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: