Provider Demographics
NPI:1003940958
Name:GOBIND L GARG MD PLLC
Entity Type:Organization
Organization Name:GOBIND L GARG MD PLLC
Other - Org Name:GOBIND L GARG MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GOBIND
Authorized Official - Middle Name:L
Authorized Official - Last Name:GARG
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:248-547-3535
Mailing Address - Street 1:13801 W 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2775
Mailing Address - Country:US
Mailing Address - Phone:248-547-3535
Mailing Address - Fax:248-547-4404
Practice Address - Street 1:13801 W 9 MILE RD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2775
Practice Address - Country:US
Practice Address - Phone:248-547-3535
Practice Address - Fax:248-547-4404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301035485207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1106321122OtherBLUE CROSS ID
MI4250333Medicaid
MI110F348860OtherBLUE CROSS
MI1106321122OtherBLUE CROSS ID
MI=========OtherCOMPANY TAX ID
MIB45695Medicare UPIN