MEDICARE: VIKRAM MAYURAN M.D.

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	208600000X	Surgery Physician	6867	GA
2	207XS0117X	Orthopaedic Surgery of the Spine Physician	67001	AZ
3	207X00000X	Orthopaedic Surgery Physician	S7129	TX
4	207X00000X	Orthopaedic Surgery Physician	MD192929	OR
5	207XS0117X	Orthopaedic Surgery of the Spine Physician	S7129	TX

General Provider Information

NPI Number	:	1568879773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIKRAM MAYURAN M.D.

Provider Business Mailing Address
First Line	:	2525 W GREENWAY RD STE 300
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85023-4292
Country	:	US
Telephone Number	:	480-573-0130
Fax Number	:	480-573-0131

Provider Business Practice Location Address
First Line	:	2563 S VAL VISTA DR STE 101
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85295-6231
Country	:	US
Telephone Number	:	480-573-0130
Fax Number	:	480-573-0131

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

Provider Enumeration Date	:	07/20/2014
Last Update Date	:	03/10/2026

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