Provider Demographics
NPI:1386875698
Name:VARGHESE, JILU J (MD)
Entity type:Individual
Prefix:DR
First Name:JILU
Middle Name:J
Last Name:VARGHESE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2255 E MOSSY OAKS RD STE 500
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-1813
Mailing Address - Country:US
Mailing Address - Phone:281-440-5300
Mailing Address - Fax:832-232-5591
Practice Address - Street 1:2255 E MOSSY OAKS RD STE 500
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77389-1813
Practice Address - Country:US
Practice Address - Phone:281-440-5300
Practice Address - Fax:832-232-5591
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08998500207Q00000X
TXR0972207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX373727202Medicaid
TX373727201Medicaid