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MYSORE N SHIVARAM MD SC
NPI 1679888341
Internal Medicine - Addiction Medicine in Berwyn, IL

Active since August 18, 2010
6901 CERMAK RD, BERWYN, IL 60402(708) 484-5660(708) 484-0194 Get Directions Write a Review

NPPES record last updated: October 15, 2014. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Mysore N Shivaram Md Sc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MYSORE N SHIVARAM MD SC (NPI 1679888341) is a healthcare organization registered as an addiction medicine in Berwyn, Illinois and active in the NPI registry since August 2010. The organization lists Mysore N Shivaram, Physician, as its authorized official.

NPPES Registry Identity

NPI1679888341
Entity TypeOrganization
Primary Taxonomy207RA0401X
Legal Business NameMYSORE N SHIVARAM MD SC
Location Address6901 CERMAK RDBerwyn, IL 60402-2160
Mailing Address6901 Cermak RdBerwyn, IL 60402-2160 · (708) 484-5660 · Fax (708) 484-0194
Phone(708) 484-5660
Fax(708) 484-0194
Organization SubpartNo
Authorized OfficialMysore N ShivaramPhysician · (708) 484-5660
Enumeration DateAugust 18, 2010
Last NPPES UpdateOctober 15, 2014
✔ NPI 1679888341 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · Addiction MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207RA0401X
License✔ Licensed in IL · 036044121
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.
6901 CERMAK RD, Berwyn, IL 60402
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Other Identifiers 3

Medicare PIN468630IL
Medicare UPIND12503IL
Medicaid036044121IL

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mysore N Shivaram MD Sc's NPI number?

The NPI number for Mysore N Shivaram MD Sc is 1679888341. It was assigned to this organization in the NPPES registry on August 18, 2010.

Where is Mysore N Shivaram MD Sc located?

Mysore N Shivaram MD Sc is located at 6901 Cermak Rd, Berwyn, IL 60402. The listed phone number is (708) 484-5660.

What is Mysore N Shivaram MD Sc's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Addiction Medicine, with taxonomy code 207RA0401X.

When was this NPI record last updated?

The NPPES record for Mysore N Shivaram MD Sc was last updated on October 15, 2014. NPI Profile syncs with the weekly NPPES data releases published by CMS.