Healthcare Provider Details

I. General information

NPI: 1467505206
Provider Name (Legal Business Name): RAVI RANJAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N 1900 E RM 4A100 HEALTH SCIENCES CENTER
SALT LAKE CITY UT
84132-0002
US

IV. Provider business mailing address

30 NORTH 1900 EAST, RM 4A100 HEALTH SCIENCES CENTER
SALT LAKE CITY UT
84132
US

V. Phone/Fax

Practice location:
  • Phone: 801-587-5888
  • Fax:
Mailing address:
  • Phone: 410-499-7024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number7682393-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number7682393-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: