Provider Demographics
NPI:1902053077
Name:VARGHESE, SAJOY PURATHUMURIYIL (MD)
Entity Type:Individual
Prefix:
First Name:SAJOY
Middle Name:PURATHUMURIYIL
Last Name:VARGHESE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4048 W COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-3502
Mailing Address - Country:US
Mailing Address - Phone:847-412-8367
Mailing Address - Fax:
Practice Address - Street 1:4048 W COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-3502
Practice Address - Country:US
Practice Address - Phone:847-412-8367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1250538712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry