Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 036.145158 | IL |
NPI | 1497199061 |
---|---|
Provider Name | Shiva Daram |
First Address | Dallas, TX 75266-0599 |
Second Address | Dallas, TX 75235-7708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2013 |
Last Update Date | 18/04/2019 |