Healthcare Provider Details

I. General information

NPI: 1255179388
Provider Name (Legal Business Name): ARANKESH MAHADEVAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 NORTH MARIO CAPECCHI DR 3RD FLOOR
SALT LAKE CITY UT
84112
US

IV. Provider business mailing address

30 NORTH MARIO CAPECCHI DR 3RD FLOOR
SALT LAKE CITY UT
84112
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-7606
  • Fax:
Mailing address:
  • Phone: 801-581-7606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number14240662-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: