Provider Demographics
NPI:1275811952
Name:RAMASUNDARAM, SIVAGAMA VALLI (MD,)
Entity Type:Individual
Prefix:DR
First Name:SIVAGAMA VALLI
Middle Name:
Last Name:RAMASUNDARAM
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:PO BOX 775383
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-5383
Mailing Address - Country:US
Mailing Address - Phone:812-376-5315
Mailing Address - Fax:
Practice Address - Street 1:3015 10TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-7090
Practice Address - Country:US
Practice Address - Phone:812-372-8426
Practice Address - Fax:812-378-7777
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01073923A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201231900Medicaid
IN000000984125OtherANTHEM PIN
IN201231900Medicaid