Organization
INTERVENTIONAL SPINE AND JOINT SPECIALISTS, LLC
Active
Organization
INTERVENTIONAL SPINE AND JOINT SPECIALISTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PRASANTH NUTHAKKI MD (CEO)
(219) 836-0296
Entity
Organization
Contact information
Practice address
701 SUPERIOR AVE STE B, MUNSTER, IN 46321-4038
(219) 333-4757
Mailing address
PO BOX 3039, MUNSTER, IN 46321-0039
Taxonomy
Speciality
Code
Description
License number
State
204R00000X
Electrodiagnostic Medicine Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
Other
Enumeration date
03/28/2019
Last updated
12/09/2020
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