Provider Demographics
NPI:1013945971
Name:RAJ K GUPTA MD PC
Entity Type:Organization
Organization Name:RAJ K GUPTA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJ
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-299-9568
Mailing Address - Street 1:10501 N TELEGRAPH ROAD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-3376
Mailing Address - Country:US
Mailing Address - Phone:313-299-9568
Mailing Address - Fax:313-299-9569
Practice Address - Street 1:10501 N TELEGRAPH ROAD
Practice Address - Street 2:SUITE 104
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-3376
Practice Address - Country:US
Practice Address - Phone:313-299-9568
Practice Address - Fax:313-299-9569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N92760Medicare ID - Type Unspecified