Provider Demographics
NPI:1992798961
Name:GARG, GOBIND L (MD)
Entity type:Individual
Prefix:DR
First Name:GOBIND
Middle Name:L
Last Name:GARG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13801 W 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2775
Mailing Address - Country:US
Mailing Address - Phone:248-547-3535
Mailing Address - Fax:248-547-4404
Practice Address - Street 1:13801 W 9 MILE RD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2775
Practice Address - Country:US
Practice Address - Phone:248-547-3535
Practice Address - Fax:248-547-4404
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301035485207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1106321122OtherBC
MI4250333Medicaid
MI1106321122OtherBC
MI4250333Medicaid
MI0N18240001Medicare PIN