| Shiva Kumar Lam, Md, Pa | |
|
1407 W Stassney Ln Austin TX 78745-2947 | |
| (512) 440-4800 | |
| (512) 440-4836 |
| Full Name | Shiva Kumar Lam, Md, Pa |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1407 W Stassney Ln, Austin, Texas |
| Authorized Official Name and Position | Allie Lam (OFFICE MANAGER) |
| Authorized Official Contact | 5124672840 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shiva Kumar Lam, Md, Pa P. O. Box 26100 Austin TX 78755 Ph: (512) 467-2840 | Shiva Kumar Lam, Md, Pa 1407 W Stassney Ln Austin TX 78745-2947 Ph: (512) 440-4800 |
| NPI Number | 1023311321 |
|---|---|
| Provider Enumeration Date | 12/09/2010 |
| Last Update Date | 09/30/2022 |
| Certification Date | 09/30/2022 |
| Medicare PECOS PAC ID | 7012175128 |
|---|---|
| Medicare Enrollment ID | O20120221000594 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023311321 | NPI | - | NPPES |
| TXB144749 | Other | MEDICARE | |
| 096990903 | Medicaid | TX | |
| 305165801 | Medicaid | TX | |
| TXB144748 | Other | MEDICARE | |
| 305165802 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Secondary |
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Shiva K Lam |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1871671032 PECOS PAC ID: 2668630781 Enrollment ID: I20120221000690 |
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