Provider Demographics
NPI:1013016732
Name:VISHWANATH, SASIKUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SASIKUMAR
Middle Name:
Last Name:VISHWANATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1073 3RD ST
Mailing Address - Street 2:
Mailing Address - City:FLORALA
Mailing Address - State:AL
Mailing Address - Zip Code:36442-3231
Mailing Address - Country:US
Mailing Address - Phone:334-858-2050
Mailing Address - Fax:334-858-2120
Practice Address - Street 1:1073 3RD ST
Practice Address - Street 2:
Practice Address - City:FLORALA
Practice Address - State:AL
Practice Address - Zip Code:36442-3231
Practice Address - Country:US
Practice Address - Phone:334-858-2050
Practice Address - Fax:334-858-2120
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19896207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003815600Medicaid
AL110173224OtherRAILROADMEDICARE
AL51037033VISOtherUNITED HEALTHCARE
FL51037033VISOtherBLUECROSS OF FLORIDA
AL103596Medicaid
AL51037033VISOtherAETNA
AL51037033VISOtherHUMANA
ALP00410027OtherRAILROAD MEDICARE
AL51524095OtherBLUCROSS OF ALABAMA
FL251015400Medicaid
AL000037033Medicare ID - Type Unspecified
AL051559331Medicare PIN
FL003815600Medicaid