Individual
VIDYA SHIVAKUMAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
839 W MADISON ST, CHICAGO, IL 60607-2631
(312) 455-3500
(312) 455-3502
Mailing address
839 W MADISON ST, CHICAGO, IL 60607-2631
(312) 455-3500
(312) 455-3502
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
036137305
IL
207N00000X
Dermatology Physician
125.059296
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036137305
STATE LICENSE
IL
Enumeration date
03/21/2012
Last updated
01/16/2024
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