Healthcare Provider Details

I. General information

NPI: 1497190359
Provider Name (Legal Business Name): PANDIAN MEDICAL CORPORATION LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2013
Last Update Date: 09/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E OGDEN AVE SUITE 106
HINSDALE IL
60521-3542
US

IV. Provider business mailing address

120 E OGDEN AVE SUITE 106
HINSDALE IL
60521-3542
US

V. Phone/Fax

Practice location:
  • Phone: 630-560-6015
  • Fax: 630-757-4140
Mailing address:
  • Phone: 630-560-6015
  • Fax: 630-757-4140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number036130036
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036130036
License Number StateIL

VIII. Authorized Official

Name: DR. SHIVKUMAR PANDIAN
Title or Position: MEDICAL DIRECTOR
Credential: M.D
Phone: 630-560-6015