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NPI Code Detail

MEDICARE: MR. VIJAY MYSORE RAVINDRA MD

MEDICARE: MR. VIJAY MYSORE RAVINDRA 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
1207T00000XNeurological Surgery PhysicianA161999CA

General Provider Information

NPI Number : 1982995841
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. VIJAY MYSORE RAVINDRA 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 : 801-662-1000
Fax Number :
Provider Business Practice Location Address
First Line : 100 N MARIO CAPECCHI DR
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84113-1103
Country : US
Telephone Number : 801-662-5351
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2011
Last Update Date : 02/09/2026

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