Provider Demographics
NPI:1003994583
Name:GARG, ANIL KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:ANIL
Middle Name:KUMAR
Last Name:GARG
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 1:6400 INDUSTRIAL LOOP
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53129-2452
Mailing Address - Country:US
Mailing Address - Phone:414-423-4100
Mailing Address - Fax:414-423-4134
Practice Address - Street 1:7978 FIELDING LN
Practice Address - Street 2:
Practice Address - City:GREENDALE
Practice Address - State:WI
Practice Address - Zip Code:53129-2112
Practice Address - Country:US
Practice Address - Phone:414-423-7199
Practice Address - Fax:414-423-7366
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20685207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIWI3049001Medicare PIN
WIWI3053001Medicare PIN
WIWI3051001Medicare PIN
WIWI3055001Medicare PIN