MEDICARE: VUTHOORI MD CORP

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	H60840	OTHER	CA	MEDICARE

General Provider Information

NPI Number	:	1003466590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VUTHOORI MD CORP

Provider Business Mailing Address
First Line	:	3061 S MARYLAND PKWY STE 202
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-6227
Country	:	US
Telephone Number	:	760-660-4790
Fax Number	:	866-554-1794

Provider Business Practice Location Address
First Line	:	3061 S MARYLAND PKWY STE 202
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-6227
Country	:	US
Telephone Number	:	760-660-4790
Fax Number	:	866-554-1794

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SRINIVAS VUTHOORI
Credential	:	MD
Telephone Number	:	760-972-6060

Provider Enumeration Date	:	09/17/2019
Last Update Date	:	05/20/2025

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Directions to “VUTHOORI MD CORP ” Practice Location

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