Healthcare Provider Details

I. General information

NPI: 1356369235
Provider Name (Legal Business Name): DR. SEEMA GARG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 W BUCHANAN AVE
CHARLESTON IL
61920-2522
US

IV. Provider business mailing address

PO BOX 372
MATTOON IL
61938-0372
US

V. Phone/Fax

Practice location:
  • Phone: 217-345-7700
  • Fax: 217-345-7200
Mailing address:
  • Phone: 217-868-2812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036099042
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number01058542
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: