Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 036102726 | IL |
N | 111NI0900X | Internist | 036102726 | IL |
N | 207RC0200X | Critical Care Medicine | 036102726 | IL |
Y | 207RP1001X | Pulmonary Disease | 036102726 | IL |
NPI | 1053338871 |
---|---|
Provider Name | Dr. Shashi Kiran Bellam |
First Address | Evanston, IL 60201-1779 |
Second Address | Evanston, IL 60201-1779 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2006 |
Last Update Date | 11/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H86631 | (02) |