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General NPI Number Information
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NPI Number | 1518985845
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Entity Type | Individual
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Provider Name | BADRI P. GUPTA MD
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Gender | Male
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 22505 ALLEN ROAD
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City | WOODHAVEN
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State | MI
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Zip | 48183
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Country | US
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Telephone | 734-671-2817
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Fax | 734-671-2917
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Provider Business Mailing Address
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Address Line | HENRY FORD HEALTH SYSTEM ONE FORD PLACE 2E
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City | DETROIT
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State | MI
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Zip | 48202
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Country | US
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Telephone | 313-874-4689
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Fax | 313-874-4677
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301060343
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License Number State | MI
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