Healthcare Provider Details

I. General information

NPI: 1164516001
Provider Name (Legal Business Name): TILAK R GARG M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2945 ORCHARD LAKE RD
KEEGO HARBOR MI
48320-1458
US

IV. Provider business mailing address

2945 ORCHARD LAKE RD
KEEGO HARBOR MI
48320-1458
US

V. Phone/Fax

Practice location:
  • Phone: 248-681-4200
  • Fax: 248-681-0818
Mailing address:
  • Phone: 248-681-4200
  • Fax: 248-681-0818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4301036931
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: