Provider Demographics
NPI:1841283819
Name:GARG, KAMLESH R (MD)
Entity type:Individual
Prefix:DR
First Name:KAMLESH
Middle Name:R
Last Name:GARG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKG0422912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
2606304912OtherBCBS MI
MI2121014Medicaid
D49336Medicare UPIN
2606304912OtherBCBS MI