Provider Demographics
NPI:1235385048
Name:KRISHNA K. GUPTA, M.D., PC
Entity Type:Organization
Organization Name:KRISHNA K. GUPTA, M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLO PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISHNA
Authorized Official - Middle Name:K
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-652-8347
Mailing Address - Street 1:1135 W UNIVERSITY DR
Mailing Address - Street 2:SUITE 325 CRITTENTON MEDICAL BUILDING
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1871
Mailing Address - Country:US
Mailing Address - Phone:248-652-8347
Mailing Address - Fax:248-650-4576
Practice Address - Street 1:1135 W UNIVERSITY DR
Practice Address - Street 2:SUITE 325 CRITTENTON MEDICAL BUILDING
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1871
Practice Address - Country:US
Practice Address - Phone:248-652-8347
Practice Address - Fax:248-650-4576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010468342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1922149376OtherNPI
MI1922149376OtherNPI