Individual
DR. PRASANTH NUTHAKKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
701 SUPERIOR AVE STE B, MUNSTER, IN 46321-4038
(219) 333-4757
(219) 401-4757
Mailing address
PO BOX 3039, MUNSTER, IN 46321-0039
(937) 985-4010
Taxonomy
Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
01071908A
IN
208100000X
Physical Medicine & Rehabilitation Physician
01071908A
IN
208VP0014X
Interventional Pain Medicine Physician
Primary
01071908A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201134860
—
IN
Enumeration date
03/28/2007
Last updated
08/01/2021
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