MEDICARE: SK RAMAN PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	ME100391	FL

General Provider Information

NPI Number	:	1265719405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SK RAMAN PA

Provider Business Mailing Address
First Line	:	3000 OASIS GRAND BLVD
Second Line	:	# 1607
City	:	FORT MYERS
State	:	FL
Zip	:	33916-1524
Country	:	US
Telephone Number	:	609-350-4757
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 OASIS GRAND BLVD
Second Line	:	# 1607
City	:	FORT MYERS
State	:	FL
Zip	:	33916-1524
Country	:	US
Telephone Number	:	609-350-4757
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SIVAKUMAR RAMAN
Credential	:
Telephone Number	:	609-350-4757

Provider Enumeration Date	:	11/15/2011
Last Update Date	:	11/15/2011

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