| NPI | 1104387521 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PRASANTH NUTHAKKI CEO 219-836-0296 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine |
| 208100000X Physical Medicine & Rehabilitation | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine | |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2020-12-09 |