Individual
SHASHIDHAR DIVAKARUNI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1730 45TH AVE, MUNSTER, IN 46321-3915
(219) 836-9677
(219) 836-0688
Mailing address
1730 45TH AVE, MUNSTER, IN 46321-3915
(219) 836-9677
(219) 836-0688
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
Primary
01040667
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000173830
ANTHEM
IN
05
—
100200170B
—
IN
01
—
90000999
BCBSIL
IL
Enumeration date
03/06/2007
Last updated
09/15/2010
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