Provider Demographics
NPI:1366628133
Name:NARENDRA K. GARG, MD, P.C.
Entity Type:Organization
Organization Name:NARENDRA K. GARG, MD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLASENOR
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:630-369-6644
Mailing Address - Street 1:1879 BAY SCOTT CIR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-1108
Mailing Address - Country:US
Mailing Address - Phone:630-369-6644
Mailing Address - Fax:630-369-3428
Practice Address - Street 1:1879 BAY SCOTT CIR
Practice Address - Street 2:SUITE 112
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-1108
Practice Address - Country:US
Practice Address - Phone:630-369-6644
Practice Address - Fax:630-369-3428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036069044207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036069044Medicaid
IL212285Medicare PIN
ILD16093Medicare UPIN