Provider Demographics
NPI:1497462428
Name:VARNADO, AARON
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:VARNADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4623 75TH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-3747
Mailing Address - Country:US
Mailing Address - Phone:414-418-8991
Mailing Address - Fax:
Practice Address - Street 1:3751 S 75TH ST APT 4
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53220-1765
Practice Address - Country:US
Practice Address - Phone:414-418-8991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver