MEDICARE: DR. KUMARASWAMY SIVAKUMAR M.D.

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	174400000X	Specialist	25540	AZ
2	2084N0400X	Neurology Physician	25540	AZ
3	2084N0600X	Clinical Neurophysiology Physician	25540	AZ
4	261QI0500X	Infusion Therapy Clinic/Center	25540	AZ
5	2084N0008X	Neuromuscular Medicine (Psychiatry & Neurology) Physician	25540	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821035254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KUMARASWAMY SIVAKUMAR M.D.

Provider Business Mailing Address
First Line	:	4545 E SHEA BLVD
Second Line	:	STE 175
City	:	PHOENIX
State	:	AZ
Zip	:	85028-3074
Country	:	US
Telephone Number	:	480-314-1007
Fax Number	:	480-314-1003

Provider Business Practice Location Address
First Line	:	4545 E SHEA BLVD
Second Line	:	STE 175
City	:	PHOENIX
State	:	AZ
Zip	:	85028-3074
Country	:	US
Telephone Number	:	480-314-1007
Fax Number	:	480-314-1003

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	08/08/2019

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Directions to “ DR. KUMARASWAMY SIVAKUMAR M.D.” Practice Location

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