Provider Demographics
NPI:1205129475
Name:SHIVKUMAR, VIKRAM (MD)
Entity type:Individual
Prefix:DR
First Name:VIKRAM
Middle Name:
Last Name:SHIVKUMAR
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 1:14 W GORE ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1114
Mailing Address - Country:US
Mailing Address - Phone:321-841-2500
Mailing Address - Fax:321-841-2477
Practice Address - Street 1:14 W GORE ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1114
Practice Address - Country:US
Practice Address - Phone:321-841-2500
Practice Address - Fax:321-841-2477
Is Sole Proprietor?:No
Enumeration Date:2011-05-22
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV267672084N0400X
FLME1520202084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology