Mysore N Shivaram Md Sc

LBN: Mysore N Shivaram Md Sc
Mysore N Shivaram Md Sc is an health care organization with primary practice located at 6901 Cermak Rd , Berwyn IL 60402-2160. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Addiction Medicine, which is considered as the primary health care specialty. Mysore N Shivaram Md Sc can be contacted via phone (708) 484-5660, or through Shivaram, Mysore N via phone (708) 484-5660.

Contact Information

Primary practice address
6901 Cermak Rd Berwyn IL 60402-2160
Phone: (708) 484-5660
Fax: (708) 484-0194
Website:
Map and Directions
Authorized official contact:
Name: Shivaram, Mysore N Doctor of Medicine (MD)
Phone: (708) 484-5660

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Addiction Medicine 207RA0401X 036044121 Illinois

Profile Details

NPI number 1679888341
LBN Legal business name Mysore N Shivaram Md Sc
DBA Doing business as
Authorized official Shivaram, Mysore N Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Aug 18th, 2010
Last updated Oct 15th, 2014 - about 11 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1679888341 NPPES
Illinois MEDICAID 036044121

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