Healthcare Provider Details

I. General information

NPI: 1417179045
Provider Name (Legal Business Name): ROBIN M GARLA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3990 JOHN R ST
DETROIT MI
48201-2018
US

IV. Provider business mailing address

PO BOX 673671
DETROIT MI
48267-3671
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-2356
  • Fax:
Mailing address:
  • Phone: 810-720-5715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601004638
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: