Healthcare Provider Details

I. General information

NPI: 1619288396
Provider Name (Legal Business Name): MILI VARGHESE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2010
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 OPTUM CIR
EDEN PRAIRIE MN
55344-2956
US

IV. Provider business mailing address

734 SEMINOLE AVE
ORLANDO FL
32804-7331
US

V. Phone/Fax

Practice location:
  • Phone: 800-561-0861
  • Fax: 800-561-0861
Mailing address:
  • Phone: 407-432-2499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME114974
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: