Provider Demographics
NPI:1467679548
Name:KAMAL GUPTA, M.D. P.C.
Entity Type:Organization
Organization Name:KAMAL GUPTA, M.D. P.C.
Other - Org Name:EYE CLINICS OF MICHIGAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-479-5580
Mailing Address - Street 1:19335 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48183-1003
Mailing Address - Country:US
Mailing Address - Phone:734-479-5580
Mailing Address - Fax:734-479-5586
Practice Address - Street 1:19335 ALLEN RD
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN TWP
Practice Address - State:MI
Practice Address - Zip Code:48183-1003
Practice Address - Country:US
Practice Address - Phone:734-479-5580
Practice Address - Fax:734-479-5586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301053683207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2844198Medicaid
MI0635960Medicare PIN