Provider Demographics
NPI:1376696807
Name:GARG, KAMAL KISHORE (MD)
Entity Type:Individual
Prefix:DR
First Name:KAMAL
Middle Name:KISHORE
Last Name:GARG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8400 PELHAM RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-3834
Mailing Address - Country:US
Mailing Address - Phone:313-291-8820
Mailing Address - Fax:313-291-4349
Practice Address - Street 1:8400 PELHAM RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-3834
Practice Address - Country:US
Practice Address - Phone:313-291-8820
Practice Address - Fax:313-291-4349
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301056605207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4163434Medicaid
MI4163434Medicaid
MIF59144Medicare UPIN