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General NPI Number Information
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NPI Number | 1265516967
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Entity Type | Individual
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Provider Name | ASHISH GUPTA MD
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Gender | Male
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 04/10/2015
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Provider Practice Location Address
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Address Line | 2070 BIDDLE AVE SUITE 1
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City | WYANDOTTE
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State | MI
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Zip | 48192-4080
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Country | US
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Telephone | 734-283-7248
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Fax | 734-283-2937
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Provider Business Mailing Address
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Address Line | 2070 BIDDLE AVE STE 1
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City | WYANDOTTE
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State | MI
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Zip | 48192-4080
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Country | US
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Telephone | 734-283-7248
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Fax | 734-283-2937
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 4301072131
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 4301072131
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License Number State | MI
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