MEDICARE: KUNTEERA TARIN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	01064237A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000722745	OTHER	IN	ANTHEM TRADITIONAL

General Provider Information

NPI Number	:	1740411305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KUNTEERA TARIN MD

Provider Business Mailing Address
First Line	:	PO BOX 108
Second Line	:
City	:	CROWN POINT
State	:	IN
Zip	:	46308-0108
Country	:	US
Telephone Number	:	219-779-8735
Fax Number	:	877-715-2312

Provider Business Practice Location Address
First Line	:	11275 DELAWARE PKWY
Second Line	:
City	:	CROWN POINT
State	:	IN
Zip	:	46307-7812
Country	:	US
Telephone Number	:	219-779-8735
Fax Number	:	877-715-2312

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2009
Last Update Date	:	03/25/2019

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Directions to “ KUNTEERA TARIN MD” Practice Location

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