Provider Demographics
NPI:1497783286
Name:GUPTA, RAJ KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:RAJ
Middle Name:KUMAR
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10501 NORTH TELEGRAPH ROAD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-3376
Mailing Address - Country:US
Mailing Address - Phone:313-299-9568
Mailing Address - Fax:313-299-9569
Practice Address - Street 1:10501 NORTH TELEGRAPH ROAD
Practice Address - Street 2:SUITE 104
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-3376
Practice Address - Country:US
Practice Address - Phone:313-299-9568
Practice Address - Fax:313-299-9569
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2024-04-06
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Provider Licenses
StateLicense IDTaxonomies
MI4301032354208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
B44689Medicare UPIN