Provider Demographics
NPI:1710625546
Name:GUPTA, PRANAY (MBBS)
Entity Type:Individual
Prefix:MR
First Name:PRANAY
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37458 FOUNTAIN PARK CIRCLE
Mailing Address - Street 2:APT 471
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185
Mailing Address - Country:US
Mailing Address - Phone:313-979-0068
Mailing Address - Fax:
Practice Address - Street 1:6245 INKSTER ROAD, GARDEN CITY HOSPITAL
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135
Practice Address - Country:US
Practice Address - Phone:919-752-9192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2023-08-09
Deactivation Date:2023-02-20
Deactivation Code:
Reactivation Date:2023-03-16
Provider Licenses
StateLicense IDTaxonomies
MI4351050356207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine