Provider Demographics
NPI:1124171533
Name:KYATHARI, SIVAMURTHY (MD)
Entity type:Individual
Prefix:DR
First Name:SIVAMURTHY
Middle Name:
Last Name:KYATHARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3945 E PARADISE FALLS DR STE 201
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-6687
Mailing Address - Country:US
Mailing Address - Phone:520-689-7030
Mailing Address - Fax:520-395-9796
Practice Address - Street 1:514 E WHITEHOUSE CANYON RD STE 110
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-0539
Practice Address - Country:US
Practice Address - Phone:520-689-7030
Practice Address - Fax:520-395-9796
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2768207R00000X
WV24117207RH0003X
AZ58983207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810017971Medicaid
NY2768OtherLICENSE