Provider Demographics
NPI:1477646743
Name:NAIR, SIVARAMAKRISHNAN S (MD)
Entity Type:Individual
Prefix:
First Name:SIVARAMAKRISHNAN
Middle Name:S
Last Name:NAIR
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 1:273 BURWICK RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44143-3818
Mailing Address - Country:US
Mailing Address - Phone:216-780-2356
Mailing Address - Fax:419-609-1123
Practice Address - Street 1:273 BURWICK RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44143-3818
Practice Address - Country:US
Practice Address - Phone:216-780-2356
Practice Address - Fax:419-502-3521
Is Sole Proprietor?:No
Enumeration Date:2006-10-01
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-0058-N174400000X
OH35040058207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH431643Medicaid
OH394250OtherWELLCARE
OH629381OtherANTHEM
OHD31192Medicare UPIN
OH431643Medicaid