Provider Demographics
NPI:1306839311
Name:GUPTA, NISHA K (MD)
Entity type:Individual
Prefix:DR
First Name:NISHA
Middle Name:K
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:19335 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48183-1003
Mailing Address - Country:US
Mailing Address - Phone:734-479-5580
Mailing Address - Fax:734-479-5586
Practice Address - Street 1:19335 ALLEN RD
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN TWP
Practice Address - State:MI
Practice Address - Zip Code:48183-1003
Practice Address - Country:US
Practice Address - Phone:734-479-5580
Practice Address - Fax:734-479-5586
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301058689207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3180118Medicaid
MIOTH000Medicare UPIN
MIOM15360Medicare ID - Type Unspecified