Provider Demographics
NPI:1487635801
Name:GUPTA, ANIL K (MD)
Entity Type:Individual
Prefix:DR
First Name:ANIL
Middle Name:K
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:32121 WOODWARD
Mailing Address - Street 2:STE. 203
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073
Mailing Address - Country:US
Mailing Address - Phone:248-549-9035
Mailing Address - Fax:248-549-9407
Practice Address - Street 1:32121 WOODWARD
Practice Address - Street 2:STE. 203
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073
Practice Address - Country:US
Practice Address - Phone:248-549-9035
Practice Address - Fax:248-549-9407
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-11
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301062010207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG80635Medicare UPIN
0M72040Medicare ID - Type Unspecified
G80635Medicare UPIN