MEDICARE: DR. LINGESH SIVANESAN MD

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	207L00000X	Anesthesiology Physician	053749	CT
2	207LC0200X	Critical Care Medicine (Anesthesiology) Physician	92494	GA
3	207L00000X	Anesthesiology Physician	92494	GA

General Provider Information

NPI Number	:	1487966396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINGESH SIVANESAN MD

Provider Business Mailing Address
First Line	:	5671 PEACHTREE DUNWOODY RD STE 530
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-5005
Country	:	US
Telephone Number	:	404-257-8601
Fax Number	:

Provider Business Practice Location Address
First Line	:	5671 PEACHTREE DUNWOODY RD STE 530
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-5005
Country	:	US
Telephone Number	:	404-257-8601
Fax Number	:

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

Provider Enumeration Date	:	07/08/2010
Last Update Date	:	12/06/2023

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