Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208800000X | Urologist | N/A | CA |
N | 2088P0231X | Pediatric Urologist | 075711 | GA |
Y | 2088P0231X | Pediatric Urologist | MD60857749 | WA |
NPI | 1033343298 |
---|---|
Provider Name | Michelle A Gupta |
First Address | Liberty Lake, WA 99019-0421 |
Second Address | Spokane, WA 99204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2009 |
Last Update Date | 25/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003177886A | (05) | GA |