Provider Demographics
NPI:1912992694
Name:SIVASWAMI, SIVARAMAN (MD)
Entity Type:Individual
Prefix:MR
First Name:SIVARAMAN
Middle Name:
Last Name:SIVASWAMI
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 1:2760 AIRPORT DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-2284
Mailing Address - Country:US
Mailing Address - Phone:614-586-0668
Mailing Address - Fax:614-586-0669
Practice Address - Street 1:2760 AIRPORT DR
Practice Address - Street 2:SUITE 120
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-2284
Practice Address - Country:US
Practice Address - Phone:614-586-0668
Practice Address - Fax:614-586-0669
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO114523207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0107441Medicaid
OH0107441Medicaid
OHH345300Medicare PIN
ILK34725Medicare ID - Type Unspecified