Individual
KRISHIN SHIVDASANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD STUDENT
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(516) 242-5027
Mailing address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(516) 242-5027
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
125.083677
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
IL
Other
Enumeration date
03/21/2022
Last updated
05/22/2024
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