Provider Demographics
NPI:1548595192
Name:SHIBU VARUGHESE MD PA
Entity type:Organization
Organization Name:SHIBU VARUGHESE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIBU
Authorized Official - Middle Name:
Authorized Official - Last Name:VARUGHESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-824-1922
Mailing Address - Street 1:12575 STONEWAY CT
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-1215
Mailing Address - Country:US
Mailing Address - Phone:718-619-0037
Mailing Address - Fax:504-309-4193
Practice Address - Street 1:9850 STIRLING RD STE 102
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33024-8068
Practice Address - Country:US
Practice Address - Phone:954-842-1922
Practice Address - Fax:504-309-4193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-14
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X, 207RH0003X, 207RH0002X, 207RE0101X
FLME104707207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty