Provider Demographics
NPI:1891757100
Name:GUPTA, SUBHASH C (MD)
Entity Type:Individual
Prefix:
First Name:SUBHASH
Middle Name:C
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:1540 LAKE LANSING RD
Mailing Address - Street 2:SUITE G06
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3756
Mailing Address - Country:US
Mailing Address - Phone:517-482-7246
Mailing Address - Fax:517-484-7377
Practice Address - Street 1:1200 E MICHIGAN AVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1800
Practice Address - Country:US
Practice Address - Phone:517-364-5330
Practice Address - Fax:517-364-5335
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
MI4301056151207L00000X, 207LP2900X, 208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3151420Medicaid
MI2919074Medicaid
MI2702808Medicaid
MIBG2138748OtherDEA
MIOC36144005Medicare ID - Type Unspecified
MIE83493Medicare UPIN
MI2702808Medicaid