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1417290065

NPI Code Detail

MEDICARE: DR. VIJAYAKUMAR TANJAVUR M.D.

MEDICARE: DR. VIJAYAKUMAR TANJAVUR M.D.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	324586	LA
2	2086S0129X	Vascular Surgery Physician	296652	LA
3	390200000X	Student in an Organized Health Care Education/Training Program
4	2086S0129X	Vascular Surgery Physician	ME164506	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	324586	OTHER	LA	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	296652	OTHER	NY	STATE LICENSE

General Provider Information

NPI Number	:	1417290065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIJAYAKUMAR TANJAVUR M.D.

Provider Business Mailing Address
First Line	:	511 MEDICAL PLAZA DR STE 101
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34748-7328
Country	:	US
Telephone Number	:	352-728-6808
Fax Number	:	352-728-1743

Provider Business Practice Location Address
First Line	:	511 MEDICAL PLAZA DR STE 101
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34748-7328
Country	:	US
Telephone Number	:	352-728-6808
Fax Number	:	352-728-1743

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

Provider Enumeration Date	:	04/02/2013
Last Update Date	:	04/07/2025

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Directions to “ DR. VIJAYAKUMAR TANJAVUR M.D.” Practice Location

Language	Start Address	Practice Location

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