MEDICARE: THOMAS P VARIED M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	4301074457	MI
2	208M00000X	Hospitalist Physician	01062740A	IN
3	207R00000X	Internal Medicine Physician	01062740A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	110240885	OTHER	MI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000613082	OTHER	IN	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	110E26038	OTHER	MI	BCBSM
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356345797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS P VARIED M.D.

Provider Business Mailing Address
First Line	:	810 PARK PL
Second Line	:
City	:	MISHAWAKA
State	:	IN
Zip	:	46545-3520
Country	:	US
Telephone Number	:	574-472-6715
Fax Number	:	574-472-6746

Provider Business Practice Location Address
First Line	:	5215 HOLY CROSS PARKWAY
Second Line	:
City	:	MISHAWAKA
State	:	IN
Zip	:	46545-1469
Country	:	US
Telephone Number	:	574-335-5000
Fax Number	:	574-472-6262

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	11/01/2024

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Directions to “ THOMAS P VARIED M.D.” Practice Location

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