Healthcare Provider Details

I. General information

NPI: 1679987127
Provider Name (Legal Business Name): ARJUN DUPATI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 05/29/2022
Certification Date: 05/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 BARCLAY CIR STE 170
ROCHESTER HILLS MI
48307-4574
US

IV. Provider business mailing address

5811 FIRWOOD DR
TROY MI
48098-2510
US

V. Phone/Fax

Practice location:
  • Phone: 248-436-4888
  • Fax: 248-294-1388
Mailing address:
  • Phone: 248-840-2188
  • Fax: 248-294-1388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number4301105283
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: