Basic Information
| Provider Information | |||||||||
| NPI: | 1245239011 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAMAN | ||||||||
| FirstName: | SIVAKUMAR | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3098 | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344783098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2392449560 | ||||||||
| FaxNumber: | 2392449481 | ||||||||
| Practice Location | |||||||||
| Address1: | 14192 METROPOLIS AVE | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339124331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2392449560 | ||||||||
| FaxNumber: | 2392449481 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2005 | ||||||||
| LastUpdateDate: | 07/16/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D0061827 | MD | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | ME100391 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 25MA08650500 | NJ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | ME100391 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 14H3T | 01 | FL | FLORIDA BLUE | OTHER | 004055400 | 05 | FL | MEDICAID | 0229181 | 05 | NJ | MEDICAID |