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General NPI Number Information
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NPI Number | 1154350304
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Entity Type | Organization
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Legal Business Name | SUBADRA SIVAKUMARAN MD PA
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Dates
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Enumeration Date | 07/01/2006
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Last Update Date | 08/26/2010
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Provider Practice Location Address
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Address Line | 4520 NW 33RD CT
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City | GAINESVILLE
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State | FL
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Zip | 32606-5937
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Country | US
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Telephone | 352-671-1111
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Fax | 352-671-1131
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Provider Business Mailing Address
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Address Line | 4520 NW 33RD CT
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City | GAINESVILLE
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State | FL
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Zip | 32606-5937
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Country | US
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Telephone | 352-671-1111
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Fax | 352-671-1131
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. KANDIAH SIVAKUMARAN
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Credential |
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Telephone | 352-375-8710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME 53303
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License Number State | FL
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