Provider Demographics
NPI:1619944311
Name:SRIHARAN, SIVASUPIRAMANIAM (MD)
Entity Type:Individual
Prefix:
First Name:SIVASUPIRAMANIAM
Middle Name:
Last Name:SRIHARAN
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 1:6400 W NEWBERRY RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605
Mailing Address - Country:US
Mailing Address - Phone:352-331-3583
Mailing Address - Fax:352-331-3669
Practice Address - Street 1:6400 W NEWBERRY RD STE 206
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4391
Practice Address - Country:US
Practice Address - Phone:352-331-3583
Practice Address - Fax:352-331-3669
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME119130207T00000X
OH35084255207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH274400Medicare PIN
MIG35566Medicare UPIN
MIOZ94601043Medicare ID - Type Unspecified
OHH274400Medicare PIN
MI006216OtherMETRAHEALTH
MI700Z946010OtherBLUE CHOICE
MI700Z946010OtherCOMMUNITY BLUE
MI700Z946010OtherBLUE CARE NETWORK
MIG35566Medicare UPIN
MIOZ94601043Medicare ID - Type Unspecified
MI4753664Medicaid
MIG35566OtherHEALTH NET FEDERAL SERVIC
MI700Z946010OtherBCBS MICHIGAN
MI1013098OtherMCLAREN HEALTH PLAN
MI1000572OtherBAY HEALTH PLAN
MI7344665OtherAETNA
MI1013098OtherHEALTH ADVANTAGE NETWORK
MIP00239544OtherMETRAHEALTH
OH0112929Medicaid