DR. MYSORE N SHIVARAM


Address: 6901 Cermak Rd, Berwyn, IL 60402-2160
Phone: 7084845660

DR. MYSORE N SHIVARAM (NPI# 1841238979) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1841238979
Entity Type Individual
Full Name DR. MYSORE N SHIVARAM
Credential M.D.
Practice Address 6901 Cermak Rd
Berwyn
IL 60402-2160
Practice Telephone 7084845660
Practice Fax Number 7084840194
Mailing Telephone 7084845660
Mailing Fax Number 7084840194
Enumeration Date 2006-06-02
Last Update Date 2010-06-22
Gender Code M
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207RA0401X Internal Medicine
Specialization: Addiction Medicine
036044121 IL Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
IL 036044121 05

Other Providers MYSORE SHIVARAM

NPI Name Taxonomy Address Enumeration
1750318903 Mysore S Shivaram Orthopaedic Surgery 7400 W Rawson Ave, #225, Franklin, WI 53132-8278 2006-06-26

Office Location

Street Address 6901 CERMAK RD
City BERWYN
State IL
Zip Code 60402-2160

Providers in the same location

NPI Name Taxonomy Address Enumeration
1679888341 Mysore N Shivaram Md Sc Internal Medicine 6901 Cermak Rd, Berwyn, IL 60402-2160 2010-08-18

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1619586518 Lisa K Anderson-shaw Clinical Ethicist Macneal Trinity Medical Cetner, 3249 Oak Park Avenue, Berwyn, IL 60402 2020-07-27
1922622380 Ayesha Ikram Internal Medicine Macneal Hospital 3249 S. Oak Park Ave, Brewyn, IL 60402 2020-06-02
1598329146 Eleanor Teoh Student in an Organized Health Care Education/Training Program Family Medicine, Macneal Family Medicine Center, 3231 Eucild Ave, 5th Floor, Berwyn, IL 60402 2019-04-30
1376013920 Virginia Mireles Behavior Technician 2317 S. Home, Berwyn, IL 60402 2018-11-27
1245709047 Saraswati Koirala Dentist 1227 S Harlem Ave Apt414, Berwyn, IL 60402 2018-11-21
1295204220 Dental Town Ltd Dentist 7106 W Cermak Rd, Berwyn, IL 60402 2018-11-20
1396231684 Toya M Gildart Counselor Pillars, 6415 Stanley Avenue, Berwyn, IL 60402 2018-07-10
1437655685 Ana Luisa Desantiago Social Worker 3245 Grove Ave Ste 201, Berwyn, IL 60402 2018-04-04
1821520198 Chetan Velagapudi Student in an Organized Health Care Education/Training Program 3231 S Euclid Avenue, Suite 203, Berwyn, IL 60402 2017-03-28
1174976567 Sydney Talavera Counselor 6415 Stanley Ave., Berwyn, IL 60402 2016-07-20
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Taxonomy Information

Taxonomy Code 207RA0401X
Grouping Allopathic & Osteopathic Physicians
Classification Internal Medicine
Specialization Addiction Medicine

Taxonomy Definition

An internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine.
Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: added definition, added source; 7/1/2011: modified source]
- Additional Resources: http://www.osteopathic.org/certification

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1679888341 Mysore N Shivaram Md Sc Internal Medicine 6901 Cermak Rd, Berwyn, IL 60402-2160 2010-08-18

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1033343132 Richard Joseph Wallyn Internal Medicine 1300 Brassie Ave., Flossmoor, IL 60422-1812 2009-05-05
1477752160 Arthur Hoffman Internal Medicine 2652 Broadway Ave, Evanston, IL 60201 2007-07-13
1659300796 Abhin Singla Internal Medicine 801 N Larkin Ave Ste 101, Joliet, IL 60435 2006-07-01
1659342665 Albert C Tanlim Internal Medicine 845 S 4th St, Roberts Clinic Ltd, Watseka, IL 60970-1628 2006-01-28
1184189672 Calumet Counseling and Dui Services,inc Internal Medicine 1010 W 95th St, Chicago, IL 60643-1522 2019-02-08
1407395346 Bhs Physician Services of Illinois PC Internal Medicine 1237 E 1600 North Rd, Gilman, IL 60938-6112 2017-02-13
1588929525 Opioid Addiction Recovery Services PC Internal Medicine 755 S Milwaukee Ave, Suite 210, Libertyville, IL 60048-3253 2012-07-05
1376819565 Sahar Eftekhar Internal Medicine 1 E Superior St Ste 306, Chicago, IL 60611-2595 2012-04-01
1942585468 Ngu Md. Wellness Ltd. Internal Medicine 400 E Randolph St, Apt 2711, Chicago, IL 60601-7329 2011-10-15
1184934036 Mary S Wenzel Internal Medicine 3730 N Lake Shore Dr, Chicago, IL 60613-4236 2010-10-13
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Competitor

Search similar providers

City BERWYN
Zip Code 60402

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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