Provider Demographics
NPI:1841225166
Name:GUPTA, ARUN (MD)
Entity Type:Individual
Prefix:DR
First Name:ARUN
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1094 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-3193
Mailing Address - Country:US
Mailing Address - Phone:734-241-7162
Mailing Address - Fax:734-241-9102
Practice Address - Street 1:1094 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-3193
Practice Address - Country:US
Practice Address - Phone:734-241-7162
Practice Address - Fax:734-241-9102
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301047791207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI357OtherHEALTH PLAN OF MICHIGAN
MI4198592Medicaid
MI0105815672OtherBLUE CARE NETWORK
MI0581567OtherBLUE CROSS BLUE SHIELD
MII4096412OtherAETNA
MI080155107OtherPALMETTO GBA
MIP00220002Medicare PIN