Provider Demographics
NPI:1366003154
Name:GARALA, JIMMY (PA)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:
Last Name:GARALA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E 87TH AVE FL A3
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7335
Mailing Address - Country:US
Mailing Address - Phone:219-738-6670
Mailing Address - Fax:
Practice Address - Street 1:101 E 87TH AVE FL A3
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7335
Practice Address - Country:US
Practice Address - Phone:219-738-6670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical