| Bal K Gupta Md Pc | |
|
11900 E Twelve Mile Rd Suite 111 Warren MI 48093-3472 | |
| (586) 573-5300 | |
| (586) 573-5304 |
| Full Name | Bal K Gupta Md Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 11900 E Twelve Mile Rd, Warren, Michigan |
| Authorized Official Name and Position | Bal Krishan Gupta (PRESIDENT) |
| Authorized Official Contact | 5865735300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bal K Gupta Md Pc 11900 E Twelve Mile Rd Suite 111 Warren MI 48093-3472 Ph: (586) 573-5300 | Bal K Gupta Md Pc 11900 E Twelve Mile Rd Suite 111 Warren MI 48093-3472 Ph: (586) 573-5300 |
| NPI Number | 1306937339 |
|---|---|
| Provider Enumeration Date | 09/27/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 5193779189 |
|---|---|
| Medicare Enrollment ID | O20050311000898 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306937339 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 4301037633 (Michigan) | Primary |
| Provider Name | Vijaya G Kotha |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1386657427 PECOS PAC ID: 6608869664 Enrollment ID: I20040406000305 |
| Provider Name | Chilakamarri Ramesh |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1578575106 PECOS PAC ID: 1052396553 Enrollment ID: I20040621000097 |
| Provider Name | Bal K Gupta |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225041353 PECOS PAC ID: 1557315546 Enrollment ID: I20110325000862 |
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