Healthcare Provider Details

I. General information

NPI: 1467496141
Provider Name (Legal Business Name): SHALINI GUPTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 02/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24474 GODDARD RD
TAYLOR MI
48180-4080
US

IV. Provider business mailing address

47753 7 MILE RD
NORTHVILLE MI
48167-9208
US

V. Phone/Fax

Practice location:
  • Phone: 313-292-7700
  • Fax: 313-292-5959
Mailing address:
  • Phone: 313-292-7700
  • Fax: 313-292-5959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301067982
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: