Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 49691 | MN |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | MD48822 | TN |
Y | 207YP0228X | Pediatric Otolaryngology | MD48822 | TN |
NPI | 1083835003 |
---|---|
Provider Name | Sivakumar Chinnadurai |
First Address | Minneapolis, MN 55404-4127 |
Second Address | Minneapolis, MN 55404-4127 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 29/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
333602100 | (05) | MN |
P00808079 | RAILROAD MEDICARE (01) | MN |