Healthcare Provider Details

I. General information

NPI: 1902500184
Provider Name (Legal Business Name): RISHITA GUPTA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22301 FOSTER WINTER DR
SOUTHFIELD MI
48075-3707
US

IV. Provider business mailing address

63 STANLEY LANE
MARKHAM ON
L3S4E3
CA

V. Phone/Fax

Practice location:
  • Phone: 248-849-3541
  • Fax: 248-849-2899
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number5151016309
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: