# ASHISH GUPTA MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740364470
- **Authorized official:** ASHISH GUPTA MD (OWNER)
- **Authorized official phone:** (734) 283-7248

## Contact information

- **Practice address:** 2070 BIDDLE AVE, SUITE 1, WYANDOTTE, MI 48192-4080
- **Practice address phone:** (734) 283-7248
- **Practice address fax:** (734) 283-2937
- **Mailing address:** 1627 MOMENTUM PL, CHICAGO, IL 60689-5316
- **Mailing address phone:** (734) 283-7248
- **Mailing address fax:** (734) 283-2937

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/25/2006
- **Last updated:** 02/25/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | P00248151 | MEDICARE RAILROAD | — |