MEDICARE: SUNIL RATHORE 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	2084N0400X	Neurology Physician	306509	LA
2	2084N0400X	Neurology Physician	71475	AZ
3	390200000X	Student in an Organized Health Care Education/Training Program
4	2084N0400X	Neurology Physician	13442359-1235	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	:	1427435635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUNIL RATHORE MD

Provider Business Mailing Address
First Line	:	175 N MEDICAL DR RM 5001
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84112-1103
Country	:	US
Telephone Number	:	801-581-2121
Fax Number	:

Provider Business Practice Location Address
First Line	:	175 N MEDICAL DR RM 5001
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84112-1103
Country	:	US
Telephone Number	:	801-581-2121
Fax Number	:

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

Provider Enumeration Date	:	04/27/2015
Last Update Date	:	03/16/2026

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Directions to “ SUNIL RATHORE MD” Practice Location

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