Individual
PUSHPA SHIVARAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1000 N OAK AVE, MARSHFIELD, WI 54449-5703
(715) 387-5267
(715) 389-3142
Mailing address
1120 15TH STREET, DEPARTMENT OF PEDIATRICS, AUGUSTA, GA 30912-0004
(706) 721-8623
(706) 721-1459
Taxonomy
Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
Primary
080240
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/24/2012
Last updated
07/06/2018
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