Basic Information
| Provider Information | |||||||||
| NPI: | 1447311873 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SEENIVASAGAM | ||||||||
| FirstName: | MAKESWARAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4849 N MESA ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799125919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9153516600 | ||||||||
| FaxNumber: | 9153516601 | ||||||||
| Practice Location | |||||||||
| Address1: | 10301 GATEWAY BLVD W STE 105 | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799257701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155959222 | ||||||||
| FaxNumber: | 9155959224 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 11/02/2017 | ||||||||
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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 | 207R00000X | K9411 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | K9411 | TX | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.