Provider Demographics
NPI:1740280049
Name:VARGHESE, JOSEPH K (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:K
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 1:2284 S BALLENGER HWY STE H-2
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-3446
Mailing Address - Country:US
Mailing Address - Phone:810-720-1144
Mailing Address - Fax:810-720-1166
Practice Address - Street 1:2284 S BALLENGER HWY STE H-2
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-3446
Practice Address - Country:US
Practice Address - Phone:810-720-1144
Practice Address - Fax:810-720-1166
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301043552207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4944058Medicaid
MI0P39220Medicare ID - Type Unspecified
MI4944058Medicaid