Healthcare Provider Details

I. General information

NPI: 1710450267
Provider Name (Legal Business Name): BETHESDA MEDICAL CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2019
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11050 GRIFFIN RD STE 104
DAVIE FL
33328-3227
US

IV. Provider business mailing address

11050 GRIFFIN RD STE 104
DAVIE FL
33328-3227
US

V. Phone/Fax

Practice location:
  • Phone: 954-824-1922
  • Fax: 954-281-9446
Mailing address:
  • Phone: 954-824-1922
  • Fax: 954-281-9446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHIBU VARUGHESE
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 504-265-8304