Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 4301076275 | MI |
NPI | 1043492341 |
---|---|
Provider Name | Dr. Ajay Gupta |
First Address | Ypsilanti, MI 48197-8633 |
Second Address | Ypsilanti, MI 48197-8633 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2007 |
Last Update Date | 30/12/2009 |