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General NPI Number Information
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NPI Number | 1336330570
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Entity Type | Individual
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Provider Name | MINI SIVADASAN I M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 3430 WHEATLAND RD BUILDING 1 SUITE 202
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City | DALLAS
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State | TX
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Zip | 75237-7523
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Country | US
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Telephone | 972-780-5888
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Fax | 972-780-5886
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Provider Business Mailing Address
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Address Line | 3430 WHEATLAND RD PAV I STE 202
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City | DALLAS
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State | TX
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Zip | 75237-5031
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Country | US
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Telephone | 972-780-5888
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Fax | 972-780-5886
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 01068886A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 55502-20
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 036126598
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | S1921
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License Number State | TX
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