Provider Demographics
NPI:1275732174
Name:BELLAM, SIVA P (MD)
Entity Type:Individual
Prefix:DR
First Name:SIVA
Middle Name:P
Last Name:BELLAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1700 SE HILLMOOR DR
Mailing Address - Street 2:STE 306
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7539
Mailing Address - Country:US
Mailing Address - Phone:772-398-6016
Mailing Address - Fax:772-337-0320
Practice Address - Street 1:1700 SE HILLMOOR DR
Practice Address - Street 2:STE 306
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7539
Practice Address - Country:US
Practice Address - Phone:772-398-6016
Practice Address - Fax:772-337-0320
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2014-02-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME70221207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL31481OtherBLUE CROSS BLUE SHIELD
FL830005561OtherRAIL ROAD MEDICARE
FL250467700Medicaid
FL2967902005OtherCIGNA
FLG28346Medicare UPIN
FL31481ZMedicare PIN