Provider Demographics
NPI:1871671032
Name:LAM, SHIVA KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIVA
Middle Name:KUMAR
Last Name:LAM
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:PO BOX 26100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78755-0100
Mailing Address - Country:US
Mailing Address - Phone:512-467-2840
Mailing Address - Fax:512-692-9158
Practice Address - Street 1:1407 W STASSNEY LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-2947
Practice Address - Country:US
Practice Address - Phone:512-440-4800
Practice Address - Fax:512-440-4836
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK49332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB144749OtherMEDICARE
TX305165802Medicaid
TXTXB144748OtherMEDICARE
TX305165801Medicaid
TX096990902Medicaid