1972742245 NPI number — DR. SRINIVAS KIRAN TANTRAVAHI MD

Table of content: DR. SRINIVAS KIRAN TANTRAVAHI MD (NPI 1972742245)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972742245 NPI number — DR. SRINIVAS KIRAN TANTRAVAHI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TANTRAVAHI
Provider First Name:
SRINIVAS
Provider Middle Name:
KIRAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972742245
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 CIRCLE OF HOPE DR STE 2100
Provider Second Line Business Mailing Address:
HUNTSMAN CANCER INSTITUTE, THE UNIVERSITY OF UTAH
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84112-5550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-585-0120
Provider Business Mailing Address Fax Number:
801-585-0124

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UNIVERSITY OF UTAH HOSPITAL
Provider Second Line Business Practice Location Address:
50 NORTH MEDICAL DRIVE
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84132-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-581-2121
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/11/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0000X , with the licence number:  7478477-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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