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Individual

DR. GEETHA SIVASUBRAMANIAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
2335 E KASHIAN LN STE 280, FRESNO, CA 93701-2211
(559) 320-1090
(559) 320-0331
Mailing address
2625 E DIVISADERO ST, FRESNO, CA 93721-1431
(559) 443-2682
(559) 443-2681

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
C168863
CA
207RI0200X
Infectious Disease Physician
Primary
C168863
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036125495
IL
01
F400140717
MEDICARE PTAN COOK COUNTY
IL
01
F400140718
MEDICARE PTAN MCHENRY COUNTY
IL
Enumeration date
04/19/2009
Last updated
03/23/2022
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