MYSORE N SHIVARAM MD SC NPI 1679888341

NPI Information

  • NPI: 1679888341
  • Provider Name: MYSORE N SHIVARAM MD SC
  • Classification: Internal Medicine - 207RA0401X
  • Specialization: Addiction Medicine
  • Entity Type: Organization
  • Address: 6901 CERMAK RD
    BERWYN, IL
    ZIP 60402
  • Phone: (708) 484-5660

Map and Directions

Get Directions

NPI Details

MYSORE N SHIVARAM MD SC is an addiction medicine internal medicine in Berwyn, IL. The provider is 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. MYSORE N SHIVARAM MD SC NPI is 1679888341. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

6901 CERMAK RD
BERWYN, IL
ZIP 60402-160
Phone: (708) 484-5660
Fax: (708) 484-0194

The provider's authorized official is Mysore N Shivaram .
The authorized official title is Physician and has the following contact phone number (708) 484-5660.

The enumeration date for this NPI number is 8/18/2010 and was last updated on 10/15/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207RA0401XInternal MedicineAddiction Medicine036044121ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1468630MEDICARE PINILLINOIS
2D12503MEDICARE UPINILLINOIS
3036044121MEDICAIDILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

Previous NPI
Next NPI