Dr. Mysore N Shivaram
Internist - Addiction Medicine
6901 Cermak Rd
Berwyn
, Illinois 60402-2160
Dr. Mysore N Shivaram
Internist - Addiction Medicine
6901 Cermak Rd
Berwyn
, Illinois 60402-2160
(708) 484-0194
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About
Features
Specialties
- Internist - Addiction Medicine
Languages spoken
- English
Location
First Address
- Dr. Mysore N Shivaram
- 6901 Cermak Rd
- Berwyn, IL
- Zip : 60402-2160
- Fax : (708) 484-0194
- Phone : (708) 484-5660
Second Address
- Dr. Mysore N Shivaram
- 6901 Cermak Rd
- Berwyn, IL
- Zip : 60402-2160
- Fax : (708) 484-0194
- Phone : (708) 484-5660
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207RA0401X | Internist - Addiction Medicine | 036044121 | IL |
National Provider Identifier
| NPI | 1841238979 |
|---|---|
| Provider Name | Dr. Mysore N Shivaram |
| First Address | Berwyn, IL 60402-2160 |
| Second Address | Berwyn, IL 60402-2160 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 02/06/2006 |
| Last Update Date | 22/06/2010 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 036044121 | (05) | IL |
| D12503 | (02) | IL |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.