Healthcare Provider Details

I. General information

NPI: 1891344792
Provider Name (Legal Business Name): MERRYL TREASA VARGHESE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2019
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 E MICHIGAN AVE STE 200
LANSING MI
48912-1806
US

IV. Provider business mailing address

788 SERVICE RD RM B301
EAST LANSING MI
48824-7013
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-9400
  • Fax: 517-487-3148
Mailing address:
  • Phone: 517-353-5100
  • Fax: 517-432-2759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number4301507383
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: