Provider Demographics
NPI:1245239011
Name:RAMAN, SIVAKUMAR (MD)
Entity Type:Individual
Prefix:
First Name:SIVAKUMAR
Middle Name:
Last Name:RAMAN
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:PO BOX 3098
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-3098
Mailing Address - Country:US
Mailing Address - Phone:239-244-9560
Mailing Address - Fax:239-244-9481
Practice Address - Street 1:14192 METROPOLIS AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4331
Practice Address - Country:US
Practice Address - Phone:239-244-9560
Practice Address - Fax:239-244-9481
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2016-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0061827207R00000X
FLME100391207R00000X, 207RI0200X
NJ25MA08650500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14H3TOtherFLORIDA BLUE
FL004055400Medicaid
NJ0229181Medicaid
I16277Medicare UPIN
NJ0229181Medicaid
MDS118P059Medicare PIN
FL004055400Medicaid