Provider Demographics
NPI:1891918348
Name:RASHMI GUPTA MD PC
Entity Type:Organization
Organization Name:RASHMI GUPTA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-354-0967
Mailing Address - Street 1:29592 NORTHWESTERN HWY
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1019
Mailing Address - Country:US
Mailing Address - Phone:248-354-0967
Mailing Address - Fax:248-354-6614
Practice Address - Street 1:29592 NORTHWESTERN HWY
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1019
Practice Address - Country:US
Practice Address - Phone:248-354-0967
Practice Address - Fax:248-354-6614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301048301174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3393108Medicaid
MIRG048301OtherSTATE LICENSE
MI350F338260OtherBCBS
MI3393108Medicaid
MI350F338260OtherBCBS
MI=========OtherFEDERAL TAX ID