Provider Demographics
NPI: | 1467618520 |
---|---|
Name: | GUPTA, MALIKA (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | MALIKA |
Middle Name: | |
Last Name: | GUPTA |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 3621 S STATE ST |
Mailing Address - Street 2: | 700 KMS PLACE |
Mailing Address - City: | ANN ARBOR |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 48108 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 734-936-2047 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 24 FRANK LLOYD WRIGHT DR |
Practice Address - Street 2: | SUITE H-2100 |
Practice Address - City: | ANN ARBOR |
Practice Address - State: | MI |
Practice Address - Zip Code: | 48105-9484 |
Practice Address - Country: | US |
Practice Address - Phone: | 734-647-6263 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2008-07-29 |
Last Update Date: | 2023-12-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MD | D0072908 | 208000000X |
MI | 4301113493 | 208000000X, 2080P0201X |
NY | 267619 | 2080P0201X |
TX | T7935 | 207RA0201X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RA0201X | Allopathic & Osteopathic Physicians | Internal Medicine | Allergy & Immunology |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | |
No | 2080P0201X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Allergy/Immunology |