Provider Demographics
NPI:1871792770
Name:SARAVANAN, SIRUMUGAI M (MD)
Entity type:Individual
Prefix:
First Name:SIRUMUGAI
Middle Name:M
Last Name:SARAVANAN
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 1:1200 W WHITE RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4988
Mailing Address - Country:US
Mailing Address - Phone:877-668-5621
Mailing Address - Fax:
Practice Address - Street 1:1116 N 16TH ST STE A
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2119
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:765-448-8807
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01064164A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000531180OtherANTHEM PROVIDER NUMBER
IN200871700Medicaid
IN142080WWWMedicare PIN
IN000000531180OtherANTHEM PROVIDER NUMBER
IN815500F2Medicare PIN
IN921480RRMedicare PIN
INP00421021Medicare PIN
IN815490BBBBMedicare PIN