Provider Demographics
NPI:1609195395
Name:GUPTA, SONYA (DO)
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13008
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48901-3008
Mailing Address - Country:US
Mailing Address - Phone:517-364-3380
Mailing Address - Fax:517-364-3399
Practice Address - Street 1:138 SERVICE RD
Practice Address - Street 2:A225 CLINICAL CENTER
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-1376
Practice Address - Country:US
Practice Address - Phone:517-353-4941
Practice Address - Fax:517-432-3145
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101018609207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine