Individual
DR. POOPALASINGHAM POOVENDRAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 HIGH PARK AVE, GOSHEN, IN 46526-4810
(574) 533-2141
Mailing address
PO BOX 308, MISHAWAKA, IN 46546-0308
(574) 273-6546
(574) 273-5295
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
01036408
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100318170
—
IN
01
—
352149231
TAX ID
IN
Enumeration date
11/15/2005
Last updated
05/02/2012
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