Healthcare Provider Details

I. General information

NPI: 1295799559
Provider Name (Legal Business Name): RAMESH P KANURU M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3445 RIDGE RD
HIGHLAND IN
46322-2049
US

IV. Provider business mailing address

3445 RIDGE RD
HIGHLAND IN
46322-2049
US

V. Phone/Fax

Practice location:
  • Phone: 219-838-1100
  • Fax:
Mailing address:
  • Phone: 219-838-1100
  • Fax: 219-923-3501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TAMMY SOBCZAK
Title or Position: OFFICE MANAGER
Credential:
Phone: 219-838-1100