Basic Information
| Provider Information | |||||||||
| NPI: | 1497199061 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | DARAM | ||||||||
| FirstName: | SHIVA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 650859 | ||||||||
| Address2: | DEPT 710 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752655302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4097476240 | ||||||||
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| Practice Location | |||||||||
| Address1: | 301 UNIVERSITY BLVD | ||||||||
| Address2: | |||||||||
| City: | GALVESTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775557708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2566943513 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2013 | ||||||||
| LastUpdateDate: | 08/01/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207YP0228X | 036.145158 | IL | N | Allopathic & Osteopathic Physicians | Otolaryngology | Pediatric Otolaryngology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207YP0228X | R2562 | TX | Y | Allopathic & Osteopathic Physicians | Otolaryngology | Pediatric Otolaryngology |
No ID Information.