Provider Demographics
NPI:1306986252
Name:SANKARAN, SIVA (MD)
Entity type:Individual
Prefix:
First Name:SIVA
Middle Name:
Last Name:SANKARAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SIVA
Other - Middle Name:
Other - Last Name:SANKARAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3296 W VIENNA RD
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-1300
Mailing Address - Country:US
Mailing Address - Phone:810-686-4030
Mailing Address - Fax:
Practice Address - Street 1:3296 W VIENNA RD
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-1300
Practice Address - Country:US
Practice Address - Phone:810-686-4030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301039199207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1102500032OtherBLUE CROSS BLUE SHIELD
MI2106116Medicaid
MI1102500032OtherBLUE CARE NETWORK
MI791021616OtherMETRAHEALTH
MAD90128OtherMETRAHEALTH
MI1100031OtherHEALTH PLUS
MI1002102OtherHEALTH ADVANTAGE NETWORK
MID90128OtherHEALTH ALLIANCE PLAN
MI1102500032OtherBLUE CHOICE
MI2106116Medicaid