Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 036-078826 | IL |
NPI | 1013082551 |
---|---|
Provider Name | Parveen K Varma |
First Address | Morris, IL 60450-9042 |
Second Address | Morris, IL 60450-9042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 20/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D93621 | (02) | IL |