Provider Demographics
NPI:1275592883
Name:SIVAKUMARAN, SUBADRA (MD)
Entity Type:Individual
Prefix:
First Name:SUBADRA
Middle Name:
Last Name:SIVAKUMARAN
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 1:4520 NW 33RD CT
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-5937
Mailing Address - Country:US
Mailing Address - Phone:352-671-1111
Mailing Address - Fax:352-671-1131
Practice Address - Street 1:2810 SE 3RD CT
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0446
Practice Address - Country:US
Practice Address - Phone:352-671-1111
Practice Address - Fax:352-671-1131
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0053303207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007295700Medicaid
FL07849OtherBCBS
FL07849AOtherMEDICARE PTAN
FL007295700Medicaid