Provider Demographics
NPI:1093729550
Name:VARGHESE, PEKKUZHIYIL ANTHRAYOSE (MD)
Entity Type:Individual
Prefix:
First Name:PEKKUZHIYIL
Middle Name:ANTHRAYOSE
Last Name:VARGHESE
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 1:8840 COMMERCE PARK PL STE E
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-3129
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 23RD ST
Practice Address - Street 2:DUNN MEMORIAL HOSPITAL
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-4704
Practice Address - Country:US
Practice Address - Phone:812-275-3331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01029175207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100268040Medicaid