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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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