Basic Information
| Provider Information | |||||||||
| NPI: | 1952373235 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAGARAJU | ||||||||
| FirstName: | SIVAKUMAR | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 WALTER ST NE STE 501 | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871022521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057273170 | ||||||||
| FaxNumber: | 5057273171 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 WALTER ST NE STE 501 | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871022521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057273170 | ||||||||
| FaxNumber: | 5057273171 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2006 | ||||||||
| LastUpdateDate: | 12/11/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/11/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 2002-0499 | NM | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RS0012X | 2002-0499 | NM | N | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine |
ID Information
| ID | Type | State | Issuer | Description | NM009E22 | 01 | NM | BCBS | OTHER | 110248672 | 01 | NM | RAILROAD MEDICARE | OTHER | 201040737 | 01 | NM | PRESBYTERIAN HEALTH/SALUD | OTHER | 850313268002 | 01 | CHAMPUS | OTHER | 756710 | 05 | AZ | MEDICAID | PROVP15697 | 01 | NM | MOLINA | OTHER | 10003714 | 01 | NM | LOVELACE HEALTH/SALUD | OTHER | 33132739 | 05 | NM | MEDICAID |