Provider Demographics
NPI:1316374176
Name:SATISH GUPTA MD
Entity Type:Organization
Organization Name:SATISH GUPTA MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-484-2261
Mailing Address - Street 1:1100 W SAGINAW ST
Mailing Address - Street 2:SUITE 620
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48915-2033
Mailing Address - Country:US
Mailing Address - Phone:517-484-2261
Mailing Address - Fax:517-484-6666
Practice Address - Street 1:1100 W SAGINAW ST
Practice Address - Street 2:SUITE 620
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48915-2033
Practice Address - Country:US
Practice Address - Phone:517-484-2261
Practice Address - Fax:517-484-6666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-10
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301102279261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1641735Medicaid
MI1641735Medicaid