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Mysore N Shivaram Md Sc
Addiction Medicine (Internal Medicine) Physician in Berwyn, Illinois
NPI 1679888341

Mysore N Shivaram Md Sc is an Addiction Medicine (Internal Medicine) Physician based in Berwyn, IL and is specialized in Addiction Medicine. Mysore N Shivaram Md Sc practices in Berwyn, IL. The NPI Number for Mysore N Shivaram Md Sc is 1679888341 and holds a License No. 036044121 (Illinois).

The current practice location address for Mysore N Shivaram Md Sc is 6901 Cermak Rd, Berwyn, IL and can be reached out via phone at 708-484-5660 and via fax at 708-484-0194.

Location: 6901 Cermak Rd, Berwyn, IL, 60402-2160
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1679888341
Provider Name
Mysore N Shivaram Md Sc
Credential
Provider Entity Type
Organization
Address
6901 Cermak Rd, Berwyn, IL, 60402-2160
Phone Number
708-484-5660
Fax Number
708-484-0194
Provider Enumeration Date
08/18/2010
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
036044121 05 IL
institution
Provider Business Practice Location Address Details
Address
6901 Cermak Rd
City
Berwyn
State
Illinois
Zip
60402-2160
Phone Number
708-484-5660
Fax Number
708-484-0194
person
Provider Business Mailing Address Details
Address
6901 Cermak Rd
City
Berwyn
State
Illinois
Zip
60402-2160
Phone Number
708-484-5660
Fax Number
708-484-0194
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Internal Medicine
Speciality
Addiction Medicine
Taxonomy
207RA0401X
License No.
036044121 (Illinois)
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.
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