Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | 4301099446 | MI |
NPI | 1033407499 |
---|---|
Provider Name | Dr. Jonathan Gupta |
First Address | Franklin, MI 48025-1123 |
Second Address | Pontiac, MI 48341-5023 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2011 |
Last Update Date | 15/02/2017 |