Provider Demographics
NPI:1801859194
Name:SYVERAIN, MILLIARDAIRE (MD)
Entity Type:Individual
Prefix:DR
First Name:MILLIARDAIRE
Middle Name:
Last Name:SYVERAIN
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 1:691 SEALE AVE
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-3833
Mailing Address - Country:US
Mailing Address - Phone:650-858-0144
Mailing Address - Fax:650-618-1661
Practice Address - Street 1:1394 TULLY RD
Practice Address - Street 2:SUITE 208
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-3057
Practice Address - Country:US
Practice Address - Phone:408-294-9234
Practice Address - Fax:408-294-9390
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81472207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG24615Medicare UPIN