Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | ME72590 | FL |
Y | 207RI0011X | Interventional Cardiology | ME72590 | FL |
NPI | 1063448488 |
---|---|
Provider Name | Dr. Siva S. Gummadi |
First Address | Ocala, FL 34471-7734 |
Second Address | Ocala, FL 34471-7734 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2006 |
Last Update Date | 17/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
253395200 | (05) | FL |
45041 | BCBS (01) | FL |
G15406 | (02) | FL |
P00209067 | RAILROAD MEDICARE (01) | FL |