Provider Demographics
NPI:1497762504
Name:AIYAPPASAMY, SIDHAIYAN (MD)
Entity Type:Individual
Prefix:MR
First Name:SIDHAIYAN
Middle Name:
Last Name:AIYAPPASAMY
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 1:1221 HAYES AVE
Mailing Address - Street 2:SUITE K
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-3345
Mailing Address - Country:US
Mailing Address - Phone:419-624-9000
Mailing Address - Fax:419-624-8866
Practice Address - Street 1:1221 HAYES AVE
Practice Address - Street 2:SUITE K
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-3345
Practice Address - Country:US
Practice Address - Phone:419-624-9000
Practice Address - Fax:419-624-8866
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35042411207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0492560Medicaid
OH0492560Medicaid
A15165Medicare UPIN