Doctor Name: | DR. JONATHAN GUPTA |
NPI Number: | 1033407499 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 4301099446 |
Business Practice Address: | 44405 Woodward Ave Pontiac, MI - 483415023 |
Business Phone Number: | 2488583000 |
Business Fax Number: | |
Mailing Address: | 5099 Commerce Rd, ORCHARD LAKE |
State: | MI |
Postal Code: | 483242201 |
Phone Number: | 2483900579 |
Fax Number: | |
NPI Enumeration Date: | 07/19/2011 |
NPI Last Update Date: | 07/19/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 4301099446 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |