Provider Demographics
NPI:1417001959
Name:SIVAKUMAR, VEERASAMY (RPT)
Entity Type:Individual
Prefix:MR
First Name:VEERASAMY
Middle Name:
Last Name:SIVAKUMAR
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8611 HICKORY DR
Mailing Address - Street 2:BUILDING 2 APT F
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-4761
Mailing Address - Country:US
Mailing Address - Phone:586-979-5517
Mailing Address - Fax:586-979-5517
Practice Address - Street 1:29510 7 MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1910
Practice Address - Country:US
Practice Address - Phone:248-427-9525
Practice Address - Fax:248-427-9528
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005743225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist