MEDICARE: UNKNOWN VARSHA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	4351053051	MI
2	207R00000X	Internal Medicine Physician	4351053051	MI
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1538917018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	UNKNOWN VARSHA M.D.

Provider Business Mailing Address
First Line	:	205 N. EAST AVE.
Second Line	:	CAB 2ND FLR. GME
City	:	JACKSON
State	:	MI
Zip	:	49201
Country	:	US
Telephone Number	:	517-205-7116
Fax Number	:	517-205-7050

Provider Business Practice Location Address
First Line	:	205 N. EAST AVE.
Second Line	:	CAB 2ND FLR. GME
City	:	JACKSON
State	:	MI
Zip	:	49201
Country	:	US
Telephone Number	:	517-205-7116
Fax Number	:	517-205-7050

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2024
Last Update Date	:	12/12/2025

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