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General NPI Number Information
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NPI Number | 1578040101
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Entity Type | Individual
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Provider Name | SIVAKUMAR RAMU PHD
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Gender | Male
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Dates
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Enumeration Date | 07/26/2018
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Last Update Date | 07/26/2018
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Provider Practice Location Address
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Address Line | 603 COUNTRY CLUB DR
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City | BENSENVILLE
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State | IL
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Zip | 60106-1329
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Country | US
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Telephone | 630-521-9708
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Fax |
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Provider Business Mailing Address
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Address Line | 6558 TEALWOOD DR
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City | LISLE
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State | IL
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Zip | 60532-3276
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Country | US
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Telephone | 312-259-6180
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Fax |
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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 | 247ZC0005X
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Taxonomy Name | Clinical Laboratory Director (Non-physician)
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License Number | 14D2142429
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License Number State | IL
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