Provider Demographics
NPI:1922149376
Name:GUPTA, KRISHNA KUMARI (MD)
Entity Type:Individual
Prefix:MRS
First Name:KRISHNA
Middle Name:KUMARI
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1135 W UNIVERSITY DRIVE
Mailing Address - Street 2:CRITTENTON MEDICAL BUILDING SUITE 325
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307
Mailing Address - Country:US
Mailing Address - Phone:248-652-8347
Mailing Address - Fax:248-650-4576
Practice Address - Street 1:1135 W UNIVERSITY DRIVE
Practice Address - Street 2:CRITTENTON MEDICAL BUILDING SUITE 325
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307
Practice Address - Country:US
Practice Address - Phone:248-652-8347
Practice Address - Fax:248-650-4576
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010468342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
O632042Medicare UPIN
MIO632042Medicare ID - Type Unspecified