Individual
JASWANTH R. GUNTAKANDLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1104 E GRACE ST, RENSSELAER, IN 47978-3211
(219) 866-5141
(219) 866-3234
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
R-8592
IA
208M00000X
Hospitalist Physician
Primary
01072068A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201213510
—
IN
Enumeration date
07/17/2009
Last updated
04/19/2023
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