Healthcare Provider Details

I. General information

NPI: 1578563102
Provider Name (Legal Business Name): ARUMUGAM SIVAKUMAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 12/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2637 W HORIZON RIDGE PKWY STE 140
HENDERSON NV
89052-4834
US

IV. Provider business mailing address

PO BOX 95067
LAS VEGAS NV
89193-5067
US

V. Phone/Fax

Practice location:
  • Phone: 702-567-8080
  • Fax: 702-567-9090
Mailing address:
  • Phone: 702-567-8080
  • Fax: 702-567-9090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number6544
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: