Individual
DR. BAL KRISHAN GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11900 E TWELVE MILE RD, SUITE 111, WARREN, MI 48093-3472
(586) 573-5300
(586) 573-5304
Mailing address
11900 E TWELVE MILE RD, SUITE 111, WARREN, MI 48093-3472
(586) 573-5300
(586) 573-5304
Taxonomy
Speciality
Code
Description
License number
State
2084F0202X
Forensic Psychiatry Physician
4301037633
MI
2084P0800X
Psychiatry Physician
Primary
4301037633
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1368788
—
MI
01
—
260E011140
BCBS
—
Enumeration date
08/13/2006
Last updated
04/22/2014
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