Organization
SHYAM M PUPPALA MDSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHYAM PUPPALA M.D. (CEO)
(773) 989-9868
Entity
Organization
Contact information
Practice address
4755 N KENMORE AVE, CHICAGO, IL 60640-5015
(773) 989-9868
(773) 989-9824
Mailing address
8 RED HILL LN, SOUTH BARRINGTON, IL 60010-6188
(773) 989-9868
(773) 989-9824
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036073281
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036073281
—
IL
Enumeration date
04/18/2008
Last updated
05/27/2008
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