Individual
DR. SHYAMSUNDER R CHAKILUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1409 E 84TH PL, REGIONAL MENTAL HEALTH CENTER, MERRILLVILLE, IN 46410-6451
(219) 794-2000
(219) 794-2010
Mailing address
8400 LOUISIANA ST, C/O GEMINUS CORPORATION, MERRILLVILLE, IN 46410-6385
(219) 757-1928
(219) 757-1950
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
01068801A
IN
2084P0804X
Child & Adolescent Psychiatry Physician
036-085813
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000700958
ANTHEM BC/BS
IN
05
—
201011930
—
IN
Enumeration date
01/26/2006
Last updated
01/19/2012
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