Healthcare Provider Details

I. General information

NPI: 1396820676
Provider Name (Legal Business Name): MICHAEL J GARCIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 08/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 CAMBRIDGE DR
JANESVILLE WI
53548-6707
US

IV. Provider business mailing address

907 CAMBRIDGE DR
JANESVILLE WI
53548-6707
US

V. Phone/Fax

Practice location:
  • Phone: 608-758-8976
  • Fax:
Mailing address:
  • Phone: 608-758-8976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number43102
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036-047663
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: