Healthcare Provider Details

I. General information

NPI: 1780909473
Provider Name (Legal Business Name): VIMLA K GARG MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 04/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8400 PELHAM RD
TAYLOR MI
48180-3834
US

IV. Provider business mailing address

25 KREGER DR
WYANDOTTE MI
48192-6258
US

V. Phone/Fax

Practice location:
  • Phone: 734-560-6498
  • Fax:
Mailing address:
  • Phone: 734-560-6498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301056332
License Number StateMI

VIII. Authorized Official

Name: DR. VIMLA GARG
Title or Position: PRESIDENT
Credential: MD
Phone: 734-560-6498