Individual
DR. NIVA SHAKYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1900 W POLK ST, CHICAGO, IL 60612-3723
(312) 864-4505
Mailing address
300 S MAPLE AVE, APT NO. D5, OAK PARK, IL 60302-3469
(773) 941-3962
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
125056869
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
XOH842983751
HMO
IL
Enumeration date
08/29/2010
Last updated
08/29/2010
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