Provider Demographics
NPI:1053055459
Name:PALANIAPPA SIVAKOLUNDU, KEERTHANA (MD)
Entity Type:Individual
Prefix:MS
First Name:KEERTHANA
Middle Name:
Last Name:PALANIAPPA SIVAKOLUNDU
Suffix:
Gender:F
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:OSF ST. FRANCIS MEDICAL CENTER, INTERNAL MEDICINE RESID
Mailing Address - Street 2:530 NE GLEN OAK AVE
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61637
Mailing Address - Country:US
Mailing Address - Phone:309-655-2730
Mailing Address - Fax:309-655-3297
Practice Address - Street 1:530 NE GLEN OAK AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61637
Practice Address - Country:US
Practice Address - Phone:309-655-2730
Practice Address - Fax:309-655-3297
Is Sole Proprietor?:No
Enumeration Date:2022-04-22
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.079672207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine