Provider Demographics
NPI:1861490856
Name:VARJABEDIAN, GREGORY (DO)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:VARJABEDIAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25500 MEADOWBROOK RD
Mailing Address - Street 2:STE 220
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1878
Mailing Address - Country:US
Mailing Address - Phone:248-477-7020
Mailing Address - Fax:248-488-7770
Practice Address - Street 1:25500 MEADOWBROOK RD
Practice Address - Street 2:STE 220
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1878
Practice Address - Country:US
Practice Address - Phone:248-477-7020
Practice Address - Fax:248-488-7770
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI009002207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2591001Medicaid
MI2591001Medicaid
MIE50171Medicare UPIN
MI0P45810003Medicare PIN