Healthcare Provider Details

I. General information

NPI: 1992798961
Provider Name (Legal Business Name): GOBIND L GARG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13801 W 9 MILE RD
OAK PARK MI
48237-2775
US

IV. Provider business mailing address

13801 W 9 MILE RD
OAK PARK MI
48237-2775
US

V. Phone/Fax

Practice location:
  • Phone: 248-547-3535
  • Fax: 248-547-4404
Mailing address:
  • Phone: 248-547-3535
  • Fax: 248-547-4404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301035485
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: