Mysore N Shivaram MD SC

Primary specialty

Addiction Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0401X

License

036044121 Issued in IL

Legal business name

MYSORE N SHIVARAM MD SC

Practice address

6901 Cermak Rd
Berwyn, IL 60402-2160

Phone

(708) 484-5660

Fax

(708) 484-0194

NPI assigned

Aug 18, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mysore N Shivaram, MD

Title

Physician

Phone

(708) 484-5660

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1282089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413331200000",
    "number": "1679888341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6901 CERMAK RD",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604022160",
            "telephone_number": "708-484-5660",
            "fax_number": "708-484-0194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6901 CERMAK RD",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604022160",
            "telephone_number": "708-484-5660",
            "fax_number": "708-484-0194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYSORE N SHIVARAM MD SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-18",
        "last_updated": "2014-10-15",
        "status": "A",
        "authorized_official_last_name": "SHIVARAM",
        "authorized_official_first_name": "MYSORE",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "708-484-5660",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "IL",
            "license": "036044121",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036044121",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Yvonne T Murphy, MD
• Anantha Krishna Murthy, MD
• My Abundant Life Therapy
• Janardhan Mydam, M.D
• Kaitlyn Myers, MSW
• Arsam Nadeem, PHARMD
• Susan M Nadis, M.D.
• Wayde Hitoshi Nagamine, M.D.
• Punya Narain
• Ashwin Narayanan

• Addiction Medicine (Internal Medicine) Physician in Berwyn, IL
• Providers in Berwyn, IL by specialty
• Addiction Medicine (Internal Medicine) Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.