1023004298 NPI number — MR. SIVAKUMAR V AMAR MD

Table of content: MR. SIVAKUMAR V AMAR MD (NPI 1023004298)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023004298 NPI number — MR. SIVAKUMAR V AMAR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMAR
Provider First Name:
SIVAKUMAR
Provider Middle Name:
V
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AMAR
Provider Other First Name:
KUMAR
Provider Other Middle Name:
V
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1023004298
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3535 LITTLE ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRINITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34655-1811
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-375-0848
Provider Business Mailing Address Fax Number:
727-375-5548

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3535 LITTLE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRINITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34655-1811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-375-0848
Provider Business Practice Location Address Fax Number:
727-375-5548
Provider Enumeration Date:
09/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  ME0038311 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: ME0038311 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 08754 . This is a "AETNA HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 102775 . This is a "METRA HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 102775 . This is a "AUMEND" identifier . This identifiers is of the category "OTHER".
  • Identifier: 290014401 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 51146 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 066422700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0008754 . This is a "GHI" identifier . This identifiers is of the category "OTHER".




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