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General NPI Number Information
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NPI Number | 1013945971
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Entity Type | Organization
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Legal Business Name | RAJ K GUPTA MD PC
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Dates
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Enumeration Date | 06/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10501 N TELEGRAPH ROAD SUITE 104
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City | TAYLOR
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State | MI
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Zip | 48180-3376
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Country | US
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Telephone | 313-299-9568
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Fax | 313-299-9569
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Provider Business Mailing Address
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Address Line | 10501 N TELEGRAPH ROAD SUITE 104
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City | TAYLOR
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State | MI
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Zip | 48180-3376
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Country | US
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Telephone | 313-299-9568
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Fax | 313-299-9569
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAJ KUMAR GUPTA
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Credential | MD
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Telephone | 313-299-9568
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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