Provider Demographics
NPI:1710947858
Name:REDDY, SIVAKUMAR (MD)
Entity Type:Individual
Prefix:
First Name:SIVAKUMAR
Middle Name:
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SIVAKUMAR
Other - Middle Name:
Other - Last Name:REDDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:TWO MEDICAL PLAZA
Practice Address - Street 2:STE 200
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661
Practice Address - Country:US
Practice Address - Phone:916-782-5106
Practice Address - Fax:916-783-5927
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A776420207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ15630ZOtherGRP ID
CAA77642OtherCALIFORNIA STATE MD LICENSE
CAA77642OtherCALIFORNIA STATE MD LICENSE