Individual
SIVA SANKAR KETHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3324 SIX FORKS RD, RALEIGH, NC 27609-7233
(919) 781-7772
Mailing address
PO BOX 603949, CHARLOTTE, NC 28260-3949
(919) 350-0351
(919) 350-7687
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
104267
MN
207R00000X
Internal Medicine Physician
52266
MN
207R00000X
Internal Medicine Physician
ME96490
FL
207RI0011X
Interventional Cardiology Physician
Primary
2018-01920
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164431284
—
NC
01
—
202WD
BCBS OF NC
NC
05
—
276408300
—
FL
05
—
ENROLLED
—
IA
05
—
ENROLLED
—
MN
01
—
NN6996A
MEDICARE
NC
01
—
P00918758
RAILROAD MEDICARE
MN
Enumeration date
08/07/2006
Last updated
01/29/2024
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