Provider Demographics
NPI:1598021750
Name:GUPTA, RAJESH (MD)
Entity type:Individual
Prefix:DR
First Name:RAJESH
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:840 OAKWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2319
Mailing Address - Country:US
Mailing Address - Phone:313-359-7600
Mailing Address - Fax:313-359-7678
Practice Address - Street 1:840 OAKWOOD BLVD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124
Practice Address - Country:US
Practice Address - Phone:856-332-4872
Practice Address - Fax:313-359-7678
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43011143922085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology