Individual provider · NPI-1

Dr. Janardhan Mydam, m.d

Hospitalist · Berwyn, IL

NPI number1396024972
StatusActive
Last updated in NPPESFeb 28, 2024

Details

NPI
1396024972
Entity type
Individual (NPI-1)
Name
Dr. Janardhan Mydam
Credential
m.d
Sex
Male
Sole proprietor
Yes
Enumeration date
Aug 12, 2011
Certification date
Feb 28, 2024
Last updated
Feb 28, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
208M00000X Hospitalist03613072ILYes
208000000X Pediatrics03613072IL
2080N0001X Pediatrics, Neonatal-Perinatal Medicine036133072IL
208000000X Pediatrics036-133072IL
208000000X Pediatrics4301095991MI

Practice location

3249 Oak Park Ave
Berwyn, IL 60402-3429

Phone 708-783-2226

Mailing address

3901 Beaubien St
3t72
Detroit, MI 48201-2119

Phone 313-745-5533

Other practice locations

3901 Beaubien St
3t72
Detroit, MI 48201-2119

Phone 313-745-5533

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