MEDICARE: DR. ANITHA VIJAYAN MD

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	207RN0300X	Nephrology Physician	111039	MO
2	207RN0300X	Nephrology Physician	13327659-1205	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194741405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANITHA VIJAYAN MD

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

Provider Business Practice Location Address
First Line	:	5169 S COTTONWOOD ST STE 320
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84107-6768
Country	:	US
Telephone Number	:	801-507-2531
Fax Number	:

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	10/19/2023

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