Healthcare Provider Details

I. General information

NPI: 1023257193
Provider Name (Legal Business Name): ANIL K GUPTA M D PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2009
Last Update Date: 05/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32121 WOODWARD AVE STE 203
ROYAL OAK MI
48073-6237
US

IV. Provider business mailing address

2798 CREEK RD
TROY MI
48098
US

V. Phone/Fax

Practice location:
  • Phone: 248-549-9035
  • Fax: 248-549-9407
Mailing address:
  • Phone: 248-641-8033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: DR. ANIL K GUPTA
Title or Position: MEMBER
Credential: M.D.
Phone: 248-549-9035