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Individual

DR. DEEPTI SHIVAKUMAR

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
675 W NORTH AVE, SUITE 416, MELROSE PARK, IL 60160-1634
(708) 681-7818
(708) 681-7903
Mailing address
675 W NORTH AVE, SUITE 416, MELROSE PARK, IL 60160-1634
(708) 681-7818
(708) 681-7903

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036128856
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0000269233
HMSA BILLING NUMBER
HI
05
59958-01
HI
Enumeration date
05/07/2007
Last updated
05/03/2021
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