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General NPI Number Information
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NPI Number | 1760453187
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Entity Type | Individual
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Provider Name | AMIT GARG MD
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Gender | Male
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Dates
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Enumeration Date | 02/01/2006
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Last Update Date | 06/13/2023
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Provider Practice Location Address
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Address Line | 6195 W 115TH ST STE A
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City | ALSIP
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State | IL
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Zip | 60803-5153
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Country | US
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Telephone | 312-262-7002
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Fax | 312-262-7005
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Provider Business Mailing Address
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Address Line | 6232 WESTERN AVE
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City | WILLOWBROOK
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State | IL
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Zip | 60527-1871
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Country | US
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Telephone | 815-674-0284
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036-112463
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License Number State | IL
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