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1871671032

NPI Code Detail

MEDICARE: DR. SHIVA KUMAR LAM MD

MEDICARE: DR. SHIVA KUMAR LAM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	K4933	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TXB144749	OTHER	TX	MEDICARE
3	TXB144748	OTHER	TX	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871671032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHIVA KUMAR LAM MD

Provider Business Mailing Address
First Line	:	PO BOX 26100
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78755-0100
Country	:	US
Telephone Number	:	512-467-2840
Fax Number	:	512-692-9158

Provider Business Practice Location Address
First Line	:	1407 W STASSNEY LN
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-2947
Country	:	US
Telephone Number	:	512-440-4800
Fax Number	:	512-440-4836

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	09/30/2022

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Directions to “ DR. SHIVA KUMAR LAM MD” Practice Location

Language	Start Address	Practice Location

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