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Individual

RAVI KANAKAMEDALA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
8840 CALUMET AVE, SUITE 103, MUNSTER, IN 46321-2529
(219) 836-7246
(219) 836-6454
Mailing address
8840 CALUMET AVE, SUITE 103, MUNSTER, IN 46321-2545
(219) 836-7246
(219) 836-6454

Taxonomy

Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
01035342A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000330862
BLUE CROSS BLUE SHEILD
IN
01
01035342A
BCBS OF IL
IL
01
01035342A
LICENSE NUMBER
IN
01
050085655
MEDICARE RAILROAD
GA
05
100259430A
IN
01
5841131
AETNA
IN
Enumeration date
07/18/2005
Last updated
08/13/2008
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