Healthcare Provider Details

I. General information

NPI: 1538134028
Provider Name (Legal Business Name): THOMAS VARGHESE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 03/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13950 W CAPITOL DRIVE
BROOKFIELD WI
53005-2441
US

IV. Provider business mailing address

13950 W CAPITOL DRIVE
BROOKFIELD WI
53005-2441
US

V. Phone/Fax

Practice location:
  • Phone: 414-302-5400
  • Fax: 414-302-5495
Mailing address:
  • Phone: 414-302-5400
  • Fax: 414-302-5495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number48234
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: