Provider Demographics
NPI:1467773960
Name:ELANGOVAN, SIVA KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SIVA
Middle Name:KUMAR
Last Name:ELANGOVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 VALLEY VIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265
Mailing Address - Country:US
Mailing Address - Phone:309-762-5560
Mailing Address - Fax:309-277-1191
Practice Address - Street 1:680 N LAKE SHORE DR STE 1425
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4451
Practice Address - Country:US
Practice Address - Phone:312-480-1387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-8953207Y00000X
IL036.136046207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology