Provider Demographics
NPI:1821122789
Name:KAMLESH R GARG MD PLLC
Entity Type:Organization
Organization Name:KAMLESH R GARG MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMLESH
Authorized Official - Middle Name:R
Authorized Official - Last Name:GARG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-547-3535
Mailing Address - Street 1:13801 W 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2775
Mailing Address - Country:US
Mailing Address - Phone:248-547-3535
Mailing Address - Fax:248-547-4404
Practice Address - Street 1:13801 W 9 MILE RD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2775
Practice Address - Country:US
Practice Address - Phone:248-547-3535
Practice Address - Fax:248-547-4404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010422912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2606304912OtherBLUE CROSS ID
MI260F304870OtherBLUE CROSS
MI432081336OtherTAX ID
MI2121014Medicaid
MI0N27030Medicare PIN
MI2121014Medicaid
MID49336Medicare UPIN