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Individual

ASHISH GUPTA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2070 BIDDLE AVE, SUITE 1, WYANDOTTE, MI 48192-4080
(734) 283-7248
(734) 283-2937
Mailing address
2070 BIDDLE AVE STE 1, WYANDOTTE, MI 48192-4080
(734) 283-7248
(734) 283-2937

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
4301072131
MI
2086S0129X
Vascular Surgery Physician
Primary
4301072131
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0208238992
BCBS
MI
05
104740862
MI
01
141876
CARE CHOICES
01
151747
GREAT LAKES HEALTH PLAN
01
17191
M-CARE
01
I33940
HAP
01
P00248151
MEDICARE RAILROAD
Enumeration date
10/25/2006
Last updated
04/10/2015
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