Healthcare Provider Details

I. General information

NPI: 1356571400
Provider Name (Legal Business Name): HARI KRISHNAN SIVANANDAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2009
Last Update Date: 02/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6908 PROVIDENCE PARK DR S
MOBILE AL
36695-4600
US

IV. Provider business mailing address

PO BOX 18981
BELFAST ME
04915-4084
US

V. Phone/Fax

Practice location:
  • Phone: 251-660-3490
  • Fax: 251-660-3491
Mailing address:
  • Phone: 251-266-3361
  • Fax: 251-266-3361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD.31875
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: