MEDICARE: SIVAKUMAR CHINNADURAI MD, MPH

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
1	207Y00000X	Otolaryngology Physician	MD48822	TN
2	207Y00000X	Otolaryngology Physician	49691	MN
3	207YP0228X	Pediatric Otolaryngology Physician	MD48822	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00808079	OTHER	MN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083835003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIVAKUMAR CHINNADURAI MD, MPH

Provider Business Mailing Address
First Line	:	2530 CHICAGO AVE STE 450
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-4127
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2530 CHICAGO AVE STE 450
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-4127
Country	:	US
Telephone Number	:	615-813-6000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	03/29/2018

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