Individual
VISHNU SUNDARESH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
50 N MEDICAL DR, SALT LAKE CITY, UT 84132-0100
(801) 581-7763
Mailing address
PO BOX 413033, SALT LAKE CITY, UT 84141-3033
(801) 213-3900
(801) 585-3655
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
8906407-1205
UT
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
8906407-1205
UT
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
8906407-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ENROLLED
—
MN
01
—
P00954344
MEDICARE RAILROAD
MN
Enumeration date
06/14/2010
Last updated
11/23/2021
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