Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 0101236333 | VA |
Y | 2080N0001X | Neonatal-Perinatal Doctor | N4757 | TX |
NPI | 1124006473 |
---|---|
Provider Name | Muraleedharan Sivarajan |
First Address | Dallas, TX 75284-5347 |
Second Address | Dallas, TX 75390-7201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2006 |
Last Update Date | 20/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I04885 | (02) |