Basic Information
| Provider Information | |||||||||
| NPI: | 1548595192 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHIBU VARUGHESE MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4760 SW 66TH TER- EAST WING | ||||||||
| Address2: | |||||||||
| City: | DAVIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333144325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186190037 | ||||||||
| FaxNumber: | 9546361208 | ||||||||
| Practice Location | |||||||||
| Address1: | 4399 N NOB HILL RD | ||||||||
| Address2: | |||||||||
| City: | SUNRISE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333515813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547490300 | ||||||||
| FaxNumber: | 9547461350 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2009 | ||||||||
| LastUpdateDate: | 11/12/2009 | ||||||||
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| AuthorizedOfficialLastName: | VARUGHESE | ||||||||
| AuthorizedOfficialFirstName: | SHIBU | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7186190037 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME104707 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.