Provider Demographics
NPI:1740288984
Name:GARG, MANISHA SINGHI (MD)
Entity type:Individual
Prefix:
First Name:MANISHA
Middle Name:SINGHI
Last Name:GARG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:26850 PROVIDENCE PKWY
Mailing Address - Street 2:PMOB 200
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1213
Mailing Address - Country:US
Mailing Address - Phone:248-465-3144
Mailing Address - Fax:248-465-3146
Practice Address - Street 1:23874 KEAN ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1804
Practice Address - Country:US
Practice Address - Phone:313-359-0801
Practice Address - Fax:313-359-2674
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301072790207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI444078610Medicaid
MIF36477095Medicare ID - Type Unspecified
MI444078610Medicaid