Provider Demographics
NPI:1659605301
Name:SIVAKUMAR AND ASSOCIATES LLC
Entity Type:Organization
Organization Name:SIVAKUMAR AND ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANUPAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIVAKUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-241-1495
Mailing Address - Street 1:2028 MUSTANG DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-6769
Mailing Address - Country:US
Mailing Address - Phone:630-241-1495
Mailing Address - Fax:630-241-1543
Practice Address - Street 1:2028 MUSTANG DR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-6769
Practice Address - Country:US
Practice Address - Phone:630-241-1495
Practice Address - Fax:630-241-1543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361120202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036112020Medicaid
ILK35923Medicare PIN
ILK50795Medicare PIN