Healthcare Provider Details

I. General information

NPI: 1952373235
Provider Name (Legal Business Name): SIVAKUMAR NAGARAJU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 WALTER ST NE STE 501
ALBUQUERQUE NM
87102-2521
US

IV. Provider business mailing address

500 WALTER ST NE STE 501
ALBUQUERQUE NM
87102-2521
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-3170
  • Fax: 505-727-3171
Mailing address:
  • Phone: 505-727-3170
  • Fax: 505-727-3171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number2002-0499
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number2002-0499
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: