Basic Information
| Provider Information | |||||||||
| NPI: | 1972742245 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TANTRAVAHI | ||||||||
| FirstName: | SRINIVAS | ||||||||
| MiddleName: | KIRAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 CIRCLE OF HOPE DR STE 2100 | ||||||||
| Address2: | HUNTSMAN CANCER INSTITUTE, THE UNIVERSITY OF UTAH | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841125550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015850120 | ||||||||
| FaxNumber: | 8015850124 | ||||||||
| Practice Location | |||||||||
| Address1: | UNIVERSITY OF UTAH HOSPITAL | ||||||||
| Address2: | 50 NORTH MEDICAL DRIVE | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841320001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015812121 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2009 | ||||||||
| LastUpdateDate: | 12/16/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0000X | 7478477-1205 | UT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology |
No ID Information.