Healthcare Provider Details

I. General information

NPI: 1366003154
Provider Name (Legal Business Name): JIMMY GARALA PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 09/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E 87TH AVE FL A3
MERRILLVILLE IN
46410-7335
US

IV. Provider business mailing address

101 E 87TH AVE FL A3
MERRILLVILLE IN
46410-7335
US

V. Phone/Fax

Practice location:
  • Phone: 219-738-6670
  • Fax:
Mailing address:
  • Phone: 219-738-6670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: