| NPI | 1679888341 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MYSORE N SHIVARAM Physician 708-484-5660 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine Addiction Medicine (Licence: IL 036044121) |
| Enumeration Date | 2010-08-18 |
| Last Update Date | 2014-10-15 |