Healthcare Provider Details

I. General information

NPI: 1093981144
Provider Name (Legal Business Name): SHIVA LAL ACHARYA MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N LAKE SHORE DR SAINT JOSEPH HOSPITAL
CHICAGO IL
60657-5773
US

IV. Provider business mailing address

440 W BARRY AVE APT- 503
CHICAGO IL
60657-5773
US

V. Phone/Fax

Practice location:
  • Phone: 773-665-3000
  • Fax:
Mailing address:
  • Phone: 312-259-1858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125052257
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: