MEDICARE: DR. INDU SIVARAMAN M.D.

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	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	35120788	OH
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1275846370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. INDU SIVARAMAN M.D.

Provider Business Mailing Address
First Line	:	35040 CHARDON RD
Second Line	:	STE 110
City	:	WILLOUGHBY HILLS
State	:	OH
Zip	:	44094-9004
Country	:	US
Telephone Number	:	440-666-2193
Fax Number	:

Provider Business Practice Location Address
First Line	:	35040 CHARDON RD STE 110
Second Line	:
City	:	WILLOUGHBY HILLS
State	:	OH
Zip	:	44094-9004
Country	:	US
Telephone Number	:	440-946-1200
Fax Number	:

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

Provider Enumeration Date	:	07/17/2010
Last Update Date	:	03/04/2026

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