Provider Demographics
NPI:1114162625
Name:GUPTA, VISHAL (MD)
Entity Type:Individual
Prefix:
First Name:VISHAL
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 67000
Mailing Address - Street 2:DEPARTMENT 272801
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-0002
Mailing Address - Country:US
Mailing Address - Phone:517-817-7618
Mailing Address - Fax:517-817-7639
Practice Address - Street 1:1100 E MICHIGAN AVE
Practice Address - Street 2:STE 310
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1847
Practice Address - Country:US
Practice Address - Phone:517-817-7618
Practice Address - Fax:517-817-7639
Is Sole Proprietor?:No
Enumeration Date:2008-12-12
Last Update Date:2010-06-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301093433207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine