Provider Demographics
NPI:1952373235
Name:NAGARAJU, SIVAKUMAR (MD)
Entity Type:Individual
Prefix:
First Name:SIVAKUMAR
Middle Name:
Last Name:NAGARAJU
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 1:500 WALTER ST NE STE 501
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2521
Mailing Address - Country:US
Mailing Address - Phone:505-727-3170
Mailing Address - Fax:505-727-3171
Practice Address - Street 1:500 WALTER ST NE STE 501
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2521
Practice Address - Country:US
Practice Address - Phone:505-727-3170
Practice Address - Fax:505-727-3171
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2002-0499207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM009E22OtherBCBS
NM110248672OtherRAILROAD MEDICARE
NM201040737OtherPRESBYTERIAN HEALTH/SALUD
850313268002OtherCHAMPUS
AZ756710Medicaid
NMPROVP15697OtherMOLINA
NM10003714OtherLOVELACE HEALTH/SALUD
NM33132739Medicaid