Healthcare Provider Details

I. General information

NPI: 1497707178
Provider Name (Legal Business Name): RAMINDER NIRULA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N MEDICAL DR
SALT LAKE CITY UT
84132-0001
US

IV. Provider business mailing address

127 S 500 E 600
SALT LAKE CITY UT
84102-1959
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-7738
  • Fax:
Mailing address:
  • Phone: 801-587-6336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number6634572-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number45679
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number6634572-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: