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NPI Code Detail

MEDICARE: DR. PHANINDRA ANTHARAM MD

MEDICARE:  DR. PHANINDRA  ANTHARAM  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
1207RC0000XCardiovascular Disease Physician14195116-1205UT

General Provider Information

NPI Number : 1811483381
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PHANINDRA ANTHARAM 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 : 395 W BULLDOG BLVD
Second Line :
City : PROVO
State : UT
Zip : 84604-3311
Country : US
Telephone Number : 801-357-7081
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2018
Last Update Date : 04/08/2026

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