Provider Demographics
NPI:1063692044
Name:VARGAS, JOHN (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:VARGAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-4600
Mailing Address - Country:US
Mailing Address - Phone:989-832-8803
Mailing Address - Fax:989-832-4134
Practice Address - Street 1:2525 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-4600
Practice Address - Country:US
Practice Address - Phone:989-832-8803
Practice Address - Fax:989-832-4134
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJV005853208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2991184Medicaid
MI0155628580OtherBLUE CROSS BLUE SHIELD
MI2991184Medicaid
MIE26206Medicare UPIN