Provider Demographics
NPI:1982666012
Name:KANAGASEGAR, SIVALINGAM (MD)
Entity Type:Individual
Prefix:
First Name:SIVALINGAM
Middle Name:
Last Name:KANAGASEGAR
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 1:49 CLEVELAND ST STE 210
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-2854
Mailing Address - Country:US
Mailing Address - Phone:931-787-1477
Mailing Address - Fax:931-787-1478
Practice Address - Street 1:49 CLEVELAND ST
Practice Address - Street 2:SUITE 350
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-9716
Practice Address - Country:US
Practice Address - Phone:931-456-5515
Practice Address - Fax:931-456-5226
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34807207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ010000Medicaid
TN103I709773Medicare PIN
TN38599441Medicare PIN
TNQ010000Medicaid