Provider Demographics
NPI:1225006687
Name:KOLIWAD, SUNEIL K (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:SUNEIL
Middle Name:K
Last Name:KOLIWAD
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 POTRERO AVE
Mailing Address - Street 2:SFGH BLDG 30, 3501K, BOX 0862
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0862
Mailing Address - Country:US
Mailing Address - Phone:415-206-3828
Mailing Address - Fax:
Practice Address - Street 1:1001 POTRERO AVE
Practice Address - Street 2:SFGH BLDG 30, 3501K, BOX 0862
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0862
Practice Address - Country:US
Practice Address - Phone:415-206-3828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83308207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A794660Medicaid
CA00A794660Medicaid
I24829Medicare UPIN
CAP00247034Medicare PIN