Organization
SHAM L GUPTA MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHAM LAL GUPTA MD (OWNER)
(734) 287-3733
Entity
Organization
Contact information
Practice address
15101 SOUTHFIELD RD, SUITE 102, ALLEN PARK, MI 48101-2697
(313) 389-9950
(313) 389-9952
Mailing address
15101 SOUTHFIELD, SUITE 102, ALLEN PARK, MI 48101
(313) 389-9950
(313) 389-9952
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1093514
—
MI
Enumeration date
05/16/2008
Last updated
02/13/2009
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