Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 02005605A | IN |
NPI | 1134547037 |
---|---|
Provider Name | Anita Sivam |
First Address | Louisville, KY 40223-2992 |
Second Address | Zionsville, IN 46077-7205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2014 |
Last Update Date | 12/07/2019 |