Provider Demographics
NPI:1295706521
Name:CHAKILUM, SHYAMSUNDER R (MD)
Entity type:Individual
Prefix:DR
First Name:SHYAMSUNDER
Middle Name:R
Last Name:CHAKILUM
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Gender:M
Credentials:MD
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Mailing Address - Street 1:8400 LOUISIANA ST
Mailing Address - Street 2:C/O GEMINUS CORPORATION
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6385
Mailing Address - Country:US
Mailing Address - Phone:219-757-1928
Mailing Address - Fax:219-757-1950
Practice Address - Street 1:1409 E 84TH PL
Practice Address - Street 2:REGIONAL MENTAL HEALTH CENTER
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6451
Practice Address - Country:US
Practice Address - Phone:219-794-2000
Practice Address - Fax:219-794-2010
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2012-01-19
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Provider Licenses
StateLicense IDTaxonomies
IL036-0858132084P0804X
IN01068801A2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000700958OtherANTHEM BC/BS
IN201011930Medicaid
INM400038107Medicare PIN
IN201011930Medicaid