Healthcare Provider Details

I. General information

NPI: 1962476184
Provider Name (Legal Business Name): RAKESH K GARG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4231 PROGRESS BLVD
PERU IL
61354
US

IV. Provider business mailing address

4231 PROGRESS BLVD
PERU IL
61354-1193
US

V. Phone/Fax

Practice location:
  • Phone: 815-223-7144
  • Fax: 815-223-7989
Mailing address:
  • Phone: 815-223-7144
  • Fax: 815-223-7989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036066140
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: