Healthcare Provider Details

I. General information

NPI: 1114345436
Provider Name (Legal Business Name): SUSHIL KUMAR GARG M,B;B,S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SUSHIL KUMAR M,B;B,S.

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 SAN PABLO RD S
JACKSONVILLE FL
32224-1865
US

IV. Provider business mailing address

PO BOX 860912
MINNEAPOLIS MN
55486-0912
US

V. Phone/Fax

Practice location:
  • Phone: 904-953-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number70785
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME179419
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number61853
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: