Basic Information
| Provider Information | |||||||||
| NPI: | 1740288984 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARG | ||||||||
| FirstName: | MANISHA | ||||||||
| MiddleName: | SINGHI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26850 PROVIDENCE PKWY | ||||||||
| Address2: | PMOB 200 | ||||||||
| City: | NOVI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483741213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2484653144 | ||||||||
| FaxNumber: | 2484653146 | ||||||||
| Practice Location | |||||||||
| Address1: | 23874 KEAN ST | ||||||||
| Address2: | |||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481241804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3133590801 | ||||||||
| FaxNumber: | 3133592674 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2005 | ||||||||
| LastUpdateDate: | 06/11/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301072790 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 444078610 | 05 | MI | MEDICAID |