Provider Demographics
NPI:1497775233
Name:SAMBARE, VARSHA (MD)
Entity Type:Individual
Prefix:DR
First Name:VARSHA
Middle Name:
Last Name:SAMBARE
Suffix:
Gender:F
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:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-0215
Mailing Address - Country:US
Mailing Address - Phone:630-378-2000
Mailing Address - Fax:
Practice Address - Street 1:485 S WEBER RD
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60490-5504
Practice Address - Country:US
Practice Address - Phone:630-378-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036102599207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036102599Medicaid
I28809Medicare UPIN
ILK17178Medicare ID - Type Unspecified