Provider Demographics
NPI:1275708380
Name:ASHOK K GUPTA MD PLC
Entity Type:Organization
Organization Name:ASHOK K GUPTA MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-663-9469
Mailing Address - Street 1:101 E SPICERVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:EATON RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:48827-1919
Mailing Address - Country:US
Mailing Address - Phone:517-663-9469
Mailing Address - Fax:517-663-9470
Practice Address - Street 1:101 E SPICERVILLE HWY
Practice Address - Street 2:
Practice Address - City:EATON RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:48827-1919
Practice Address - Country:US
Practice Address - Phone:517-663-9469
Practice Address - Fax:517-663-9470
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASHOK K GUPTA MD PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-29
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301048680207R00000X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI10 1833420Medicaid
MIAG048680OtherBCBSM LICENSE #
MIB44349Medicare UPIN