Provider Demographics
NPI:1447519681
Name:GUPTA, HEATHER CHRISTINE (MD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:CHRISTINE
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6530 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3216
Mailing Address - Country:US
Mailing Address - Phone:248-661-6421
Mailing Address - Fax:248-661-7210
Practice Address - Street 1:6530 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3216
Practice Address - Country:US
Practice Address - Phone:248-661-6421
Practice Address - Fax:248-661-7210
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301103932208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics