Organization
PAIN MANAGEMENT CENTER OF SOUTHERN INDIANA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAMAL KUMAR TIWARI MD (PRESIDENT)
(812) 333-7246
Entity
Organization
Contact information
Practice address
2920 MCINTYRE DR, SUITE 150, BLOOMINGTON, IN 47403-4221
(812) 333-7246
(812) 333-4471
Mailing address
PO BOX 5635, BLOOMINGTON, IN 47407-5635
(812) 337-5003
(812) 337-5010
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
50003765A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100389270
—
IN
Enumeration date
09/15/2005
Last updated
06/15/2009
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