Provider Demographics
NPI:1578624474
Name:SIVKIN, MIRIAM J (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:J
Last Name:SIVKIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3267
Mailing Address - Country:US
Mailing Address - Phone:203-783-0543
Mailing Address - Fax:203-874-5728
Practice Address - Street 1:247 BROAD ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3267
Practice Address - Country:US
Practice Address - Phone:203-783-0543
Practice Address - Fax:203-874-5728
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT029814207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT127938OtherPREFERRED ONE WELLCARE
CT161664854OtherTAX I.D. NO
CTZP116OtherOXFORD
CO010029814CT01OtherANTHEM I.D. NO.
CT2V3325OtherHEALTHNET
CT004237112Medicaid
CT029814OtherCONNECTICARE
CT029814OtherCONNECTICARE
CTE04340Medicare UPIN