Provider Demographics
NPI:1023004298
Name:AMAR, SIVAKUMAR V (MD)
Entity Type:Individual
Prefix:MR
First Name:SIVAKUMAR
Middle Name:V
Last Name:AMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:KUMAR
Other - Middle Name:V
Other - Last Name:AMAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3535 LITTLE ROAD
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1811
Mailing Address - Country:US
Mailing Address - Phone:727-375-0848
Mailing Address - Fax:727-375-5548
Practice Address - Street 1:3535 LITTLE ROAD
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-1811
Practice Address - Country:US
Practice Address - Phone:727-375-0848
Practice Address - Fax:727-375-5548
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0038311207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
08754OtherAETNA HUMANA
102775OtherMETRA HEALTH
102775OtherAUMEND
290014401OtherRAILROAD MEDICARE
51146OtherBLUE CROSS BLUE SHIELD
FL066422700Medicaid
0008754OtherGHI
102775OtherAUMEND
51146OtherBLUE CROSS BLUE SHIELD