Provider Demographics
NPI:1326157983
Name:KATHAPERUMAL, SIVAPATHASEKAR
Entity Type:Individual
Prefix:
First Name:SIVAPATHASEKAR
Middle Name:
Last Name:KATHAPERUMAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12871 JASMINE CT
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-1160
Mailing Address - Country:US
Mailing Address - Phone:586-254-1967
Mailing Address - Fax:
Practice Address - Street 1:15918 19 MILE RD STE 150
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1101
Practice Address - Country:US
Practice Address - Phone:586-228-0240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501005896OtherLICENSE#