Provider Demographics
NPI:1194804385
Name:GARG, PAWAN K (MD)
Entity type:Individual
Prefix:MR
First Name:PAWAN
Middle Name:K
Last Name:GARG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2814 ELECTRIC
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192
Mailing Address - Country:US
Mailing Address - Phone:734-284-6050
Mailing Address - Fax:734-284-6552
Practice Address - Street 1:2814 ELECTRIC
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192
Practice Address - Country:US
Practice Address - Phone:734-284-6050
Practice Address - Fax:734-284-6552
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0474482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1984873Medicaid
MI1984873Medicaid
A17306Medicare UPIN