Provider Demographics
NPI:1447432463
Name:MUNNANGI, SIVAKUMAR REDDY (MD)
Entity Type:Individual
Prefix:DR
First Name:SIVAKUMAR
Middle Name:REDDY
Last Name:MUNNANGI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:386 W OLIVE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-3137
Mailing Address - Country:US
Mailing Address - Phone:209-724-9900
Mailing Address - Fax:209-724-9901
Practice Address - Street 1:386 W OLIVE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-3137
Practice Address - Country:US
Practice Address - Phone:209-724-9900
Practice Address - Fax:209-724-9901
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA052645207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A526450Medicaid
CAG64377Medicare UPIN
CA00A526450Medicare PIN