Provider Demographics
NPI:1063597698
Name:GARG, KAVITA (MD)
Entity type:Individual
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First Name:KAVITA
Middle Name:
Last Name:GARG
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:11995 SINGLETREE LN STE 500
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5349
Mailing Address - Country:US
Mailing Address - Phone:952-595-1301
Mailing Address - Fax:612-294-4903
Practice Address - Street 1:2880 CLINTON ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-2958
Practice Address - Country:US
Practice Address - Phone:952-595-1100
Practice Address - Fax:612-294-4903
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2018-10-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
COCDRH.00315062085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COF72050Medicare PIN
CO01315068Medicaid