Individual
VIJU VARGHESE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
801 BROADWAY N, FARGO, ND 58102-3641
(701) 234-2000
Mailing address
SANFORD BROADWAY CLINIC, 801 BROADWAY NORTH, FARGO, ND 58102-4662
(765) 491-8470
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
390200000
ND
207R00000X
Internal Medicine Physician
PT14741
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1700292208
HOSPITALIST, INTERNAL MEDICINE
ND
Enumeration date
07/03/2014
Last updated
07/21/2022
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