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General NPI Number Information
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NPI Number | 1477181071
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Entity Type | Individual
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Provider Name | KEVIN CHACKO VARGHESE DO
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Gender | Male
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Dates
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Enumeration Date | 03/30/2020
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 350 N WALL ST
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City | KANKAKEE
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State | IL
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Zip | 60901-2901
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Country | US
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Telephone | 815-933-1671
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Fax | 815-933-0662
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Provider Business Mailing Address
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Address Line | 400 S KENNEDY DR STE 300
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City | BRADLEY
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State | IL
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Zip | 60915-2682
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Country | US
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Telephone | 815-937-1237
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Fax | 815-933-0662
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036171273
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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