| Anita Sivasubramanian M.d., Inc | |
|
7035 N Chestnut Ave Ste 105 Fresno CA 93720-0352 | |
| (559) 353-2300 | |
| (559) 353-2323 |
| Full Name | Anita Sivasubramanian M.d., Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 7035 N Chestnut Ave Ste 105, Fresno, California |
| Authorized Official Name and Position | Anita Sivasubramanian (OWNER) |
| Authorized Official Contact | 5593609589 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Anita Sivasubramanian M.d., Inc 7035 N Chestnut Ave Ste 105 Fresno CA 93720-0352 Ph: (559) 353-2300 | Anita Sivasubramanian M.d., Inc 7035 N Chestnut Ave Ste 105 Fresno CA 93720-0352 Ph: (559) 353-2300 |
| NPI Number | 1679701262 |
|---|---|
| Provider Enumeration Date | 06/23/2009 |
| Last Update Date | 01/28/2020 |
| Medicare PECOS PAC ID | 1254485386 |
|---|---|
| Medicare Enrollment ID | O20090824000565 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679701262 | NPI | - | NPPES |
| 00A743870 | Medicaid | CA | |
| CB885A | Other | CA | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A74387 (California) | Primary |
| Provider Name | Anita Sivasubramanian |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1447260328 PECOS PAC ID: 6709930837 Enrollment ID: I20090824000561 |
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