MEDICARE: DR. VIDYA MALINI RAJ KRISHNAMURTHY 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	207R00000X	Internal Medicine Physician	MD2012-0679	NM
2	207R00000X	Internal Medicine Physician	57012504	OH
3	207RN0300X	Nephrology Physician	7298413-1205	UT

General Provider Information

NPI Number	:	1528184538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIDYA MALINI RAJ KRISHNAMURTHY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 27128
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0128
Country	:	US
Telephone Number	:	801-507-4384
Fax Number	:

Provider Business Practice Location Address
First Line	:	5121 S COTTONWOOD ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-5701
Country	:	US
Telephone Number	:	801-507-4384
Fax Number	:

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

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	03/31/2022

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