Basic Information
| Provider Information | |||||||||
| NPI: | 1356571400 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIVANANDAM | ||||||||
| FirstName: | HARI | ||||||||
| MiddleName: | KRISHNAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 18981 | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049154084 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2512663361 | ||||||||
| FaxNumber: | 2512663361 | ||||||||
| Practice Location | |||||||||
| Address1: | 6908 PROVIDENCE PARK DR S | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366954600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516603490 | ||||||||
| FaxNumber: | 2516603491 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2009 | ||||||||
| LastUpdateDate: | 02/15/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208000000X | MD.31875 | AL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 203602 | 05 | AL | MEDICAID |