Individual
KANNAN KANDALLU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5454 HOHMAN AVE, HAMMOND, IN 46320-1931
(219) 933-2006
(219) 738-6714
Mailing address
55 E 86TH AVE, PO BOX 10645, MERRILLVILLE, IN 46410-6382
(219) 769-1670
(216) 738-6714
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01046704
IN
2085R0204X
Vascular & Interventional Radiology Physician
01046704
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200157240
—
IN
Enumeration date
10/19/2005
Last updated
01/25/2012
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