MEDICARE: SARAVANAN VALLIAPPAN MD

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	16477	NV

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00950241	OTHER	TX	RR MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	515207	OTHER	AZ	AHCCCS
4	263650	OTHER	AZ	VRL
5	8CT588	OTHER	TX	BCBS TX

NPI Number	:	1003805045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAVANAN VALLIAPPAN MD

Provider Business Mailing Address
First Line	:	PO BOX 30077
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84130-0077
Country	:	US
Telephone Number	:	702-477-0772
Fax Number	:

Provider Business Practice Location Address
First Line	:	5495 S RAINBOW BLVD STE 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-1872
Country	:	US
Telephone Number	:	702-477-0772
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	10/20/2017

5495 S RAINBOW BLVD STE 102
LAS VEGAS, NV
89118-1872

Practice Phone: 702-478-2424
Practice Fax: 702-735-9074

5495 S RAINBOW BLVD STE 101
LAS VEGAS, NV
89118-1872