Provider Demographics
NPI:1023311321
Name:SHIVA KUMAR LAM, MD, PA
Entity type:Organization
Organization Name:SHIVA KUMAR LAM, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-467-2840
Mailing Address - Street 1:P. O. BOX 26100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78755
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-09
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB144749OtherMEDICARE
TX096990903Medicaid
TX305165801Medicaid
TXB144748OtherMEDICARE
TX305165802Medicaid