Individual
SHANU KONDAMURI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8840 CALUMET AVE, SUITE 103, MUNSTER, IN 46321-2545
(219) 836-7246
(219) 836-6454
Mailing address
8840 CALUMET AVE, SUITE 103, MUNSTER, IN 46321-2545
(219) 836-7246
(219) 836-6454
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
01045126A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000330844
BLUE CROSS BLUE SHIELD
IN
01
—
01045126A
BCBS OF ILLINOIS
IL
01
—
01045126A
LICENSE NUMBER
IN
01
—
050043847
MEDICARE RAILROAD
GA
05
—
200111560A
—
IN
Enumeration date
07/14/2005
Last updated
12/15/2011
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