=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437108859
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SATISH K GUPTA MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2006
-----------------------------------------------------
Last Update Date | 07/26/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4265 FIVE OAKS DR
-----------------------------------------------------
City | LANSING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48911-4214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-484-2261
-----------------------------------------------------
Fax | 517-484-6666
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4265 FIVE OAKS DR
-----------------------------------------------------
City | LANSING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48911-4214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-484-2261
-----------------------------------------------------
Fax | 517-484-6666
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207K00000X
-----------------------------------------------------
Taxonomy Name | Allergy & Immunology Physician
-----------------------------------------------------
License Number | SG039537
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------