Healthcare Provider Details

I. General information

NPI: 1265728729
Provider Name (Legal Business Name): TARA LORETH VARONI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 09/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 S LINCOLN RD SUITE 100
ESCANABA MI
49829-1292
US

IV. Provider business mailing address

26374 NETWORK PL
CHICAGO IL
60673-1263
US

V. Phone/Fax

Practice location:
  • Phone: 906-786-4628
  • Fax:
Mailing address:
  • Phone: 906-225-3630
  • Fax: 906-225-4537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101019305
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: