Provider Demographics
NPI:1578726253
Name:PANDIAN, SHIVKUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIVKUMAR
Middle Name:
Last Name:PANDIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E OGDEN AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3542
Mailing Address - Country:US
Mailing Address - Phone:630-560-6015
Mailing Address - Fax:630-757-4140
Practice Address - Street 1:120 E OGDEN AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3542
Practice Address - Country:US
Practice Address - Phone:630-560-6015
Practice Address - Fax:630-757-4140
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361300362084P0802X, 2084P0800X
NV132672084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN260002881Medicare PIN