Provider Demographics
NPI:1740326446
Name:VARANI, JOHN PAUL (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PAUL
Last Name:VARANI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12470 MARGARET DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-8856
Mailing Address - Country:US
Mailing Address - Phone:810-629-8179
Mailing Address - Fax:
Practice Address - Street 1:12470 MARGARET DR
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-8856
Practice Address - Country:US
Practice Address - Phone:810-629-8179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101004055103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B57641Medicare ID - Type UnspecifiedPSYCHIATRIC OUTPATIENT