Individual
KULUMANI M SIVARAJAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2614 W JEFFERSON ST, JOLIET, IL 60435
(815) 725-1355
(815) 725-9857
Mailing address
1860 PAYSPHERE CIR, CHICAGO, IL 60674-0018
(630) 469-9200
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
036062941
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036062941
—
IL
01
—
205474004
MEDICARE INDIV ID# FOR GROUP 205474
IL
01
—
830001948
MEDICARE RR
IL
01
—
L29321
MEDICARE INDIV ID# FOR GROUP 336140
IL
Enumeration date
09/20/2005
Last updated
06/16/2022
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