Individual
SIVAKUMAR CHINNADURAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, MPH
Contact information
Practice address
2530 CHICAGO AVE STE 450, MINNEAPOLIS, MN 55404-4127
(615) 813-6000
Mailing address
2530 CHICAGO AVE STE 450, MINNEAPOLIS, MN 55404-4127
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
49691
MN
207Y00000X
Otolaryngology Physician
MD48822
TN
207YP0228X
Pediatric Otolaryngology Physician
Primary
MD48822
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
333602100
—
MN
01
—
P00808079
RAILROAD MEDICARE
MN
Enumeration date
05/01/2007
Last updated
03/29/2018
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