Provider Demographics
NPI:1114118981
Name:ASHOK GUPTA, M.D., P.L.L.C.
Entity Type:Organization
Organization Name:ASHOK GUPTA, M.D., P.L.L.C.
Other - Org Name:ASHOK GUPTA, M.D., P.L.L.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHOK
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-681-6577
Mailing Address - Street 1:PO BOX 645
Mailing Address - Street 2:
Mailing Address - City:KEEGO HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48320-0645
Mailing Address - Country:US
Mailing Address - Phone:248-681-6577
Mailing Address - Fax:
Practice Address - Street 1:2200 BEECHMONT ST
Practice Address - Street 2:
Practice Address - City:KEEGO HARBOR
Practice Address - State:MI
Practice Address - Zip Code:48320-1460
Practice Address - Country:US
Practice Address - Phone:248-681-6577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301042770207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB44353OtherUPIN
MI103507272Medicaid
MI4301042770OtherLICENSE
MIAG9367221OtherDEA
MI0P20810Medicare PIN