Provider Demographics
NPI:1376687228
Name:RAM S. GARG, MD, PC
Entity Type:Organization
Organization Name:RAM S. GARG, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:GARG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-671-8744
Mailing Address - Street 1:14625 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-4637
Mailing Address - Country:US
Mailing Address - Phone:734-671-8744
Mailing Address - Fax:734-671-7654
Practice Address - Street 1:14625 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-4637
Practice Address - Country:US
Practice Address - Phone:734-671-8744
Practice Address - Fax:734-671-7654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058088174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0828363OtherBLUE CROSS
MI291576310Medicaid
MI291576310Medicaid
MI0828363OtherBLUE CROSS