Provider Demographics
NPI:1184663742
Name:GARG, SHAMILA (MD)
Entity Type:Individual
Prefix:
First Name:SHAMILA
Middle Name:
Last Name:GARG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E DAY RD
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3455
Mailing Address - Country:US
Mailing Address - Phone:574-204-7260
Mailing Address - Fax:574-204-7261
Practice Address - Street 1:301 E DAY RD
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3455
Practice Address - Country:US
Practice Address - Phone:574-204-7260
Practice Address - Fax:574-204-7261
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0430931207RH0003X
MO2001025565207RH0003X
NE27442207RH0003X
PAMD440186207RH0003X
NY257793207RH0003X
IN01078317A207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03236275Medicaid
IN300006950Medicaid
PA1024963730001Medicaid
7190594OtherAETNA
MOI19065Medicare UPIN
PA188680N82Medicare PIN