Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 4301094442 | MI |
NPI | 1013147586 |
---|---|
Provider Name | Chirag Gupta |
First Address | Southfield, MI 48034-1331 |
Second Address | Southfield, MI 48034-1331 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2009 |
Last Update Date | 21/10/2020 |