Healthcare Provider Details

I. General information

NPI: 1366607301
Provider Name (Legal Business Name): SIBI VARGHESE IPE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SIBI VARGHESE VARGHESE PA-C

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 CENTRAL EXPY N STE 235
ALLEN TX
75013-6135
US

IV. Provider business mailing address

1105 CENTRAL EXPY N STE 235
ALLEN TX
75013-6135
US

V. Phone/Fax

Practice location:
  • Phone: 972-747-6042
  • Fax: 972-747-6043
Mailing address:
  • Phone: 972-747-6042
  • Fax: 972-747-6043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA05723
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: