Provider Demographics
NPI:1437108859
Name:GUPTA, SATISH K (MD)
Entity type:Individual
Prefix:DR
First Name:SATISH
Middle Name:K
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4265 FIVE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4214
Mailing Address - Country:US
Mailing Address - Phone:517-484-2261
Mailing Address - Fax:517-484-6666
Practice Address - Street 1:4265 FIVE OAKS DR
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4214
Practice Address - Country:US
Practice Address - Phone:517-484-2261
Practice Address - Fax:517-484-6666
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISG039537207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI030330011OtherBCBS
MIP58801OtherBCN
MI0200611OtherPHP
MI1641735Medicaid
MIP58801OtherBCN
MI0200611OtherPHP