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General NPI Number Information
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NPI Number | 1558636647
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Entity Type | Individual
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Provider Name | VIDYA SHIVAKUMAR M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/21/2012
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Last Update Date | 01/16/2024
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Provider Practice Location Address
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Address Line | 839 W MADISON ST
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City | CHICAGO
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State | IL
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Zip | 60607-2631
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Country | US
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Telephone | 312-455-3500
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Fax | 312-455-3502
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Provider Business Mailing Address
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Address Line | 839 W MADISON ST
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City | CHICAGO
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State | IL
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Zip | 60607-2631
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Country | US
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Telephone | 312-455-3500
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Fax | 312-455-3502
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 125.059296
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 036137305
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License Number State | IL
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