Provider Demographics
NPI:1174815195
Name:GUPTA ENT CENTER WEST, PLC
Entity Type:Organization
Organization Name:GUPTA ENT CENTER WEST, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:K
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-549-9035
Mailing Address - Street 1:32121 WOODWARD AVE
Mailing Address - Street 2:STE 203
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-6237
Mailing Address - Country:US
Mailing Address - Phone:248-549-9035
Mailing Address - Fax:248-549-9407
Practice Address - Street 1:33200 W 14 MILE RD
Practice Address - Street 2:STE 240
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3563
Practice Address - Country:US
Practice Address - Phone:248-539-9060
Practice Address - Fax:248-539-9202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Y00000X
MI4301062010332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No332S00000XSuppliersHearing Aid EquipmentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI4846Medicare PIN