Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 4301047791 | MI |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 4301047791 | MI |
NPI | 1841225166 |
---|---|
Provider Name | Dr. Arun Gupta |
First Address | Monroe, MI 48162-3193 |
Second Address | Monroe, MI 48162-3193 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 30/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0105815672 | BLUE CARE NETWORK (01) | MI |
0581567 | BLUE CROSS BLUE SHIELD (01) | MI |
080155107 | PALMETTO GBA (01) | MI |
357 | HEALTH PLAN OF MICHIGAN (01) | MI |
4198592 | (05) | MI |
B79556 | (02) | |
I4096412 | AETNA (01) | MI |