Organization
PAIN MANAGEMENT SPECIALISTS LLC
Active
Organization
PAIN MANAGEMENT SPECIALISTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANU KONDAMURI M.D. (MEDICAL DIRECTOR)
(219) 836-7246
Entity
Organization
Contact information
Practice address
8840 CALUMET AVE, SUITE 103, MUNSTER, IN 46321-4037
(219) 836-7246
(219) 836-6454
Mailing address
8840 CALUMET AVE, SUITE 103, MUNSTER, IN 46321-4037
(219) 836-7246
(219) 836-6454
Taxonomy
Speciality
Code
Description
License number
State
261QP3300X
Pain Clinic/Center
Primary
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000388635
ANTHEM
IN
05
—
200531330A
—
IN
01
—
90001240
BCBS IL
IN
01
—
DE2009
RAILROAD MEDICARE
GA
Enumeration date
07/15/2005
Last updated
12/15/2011
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