Healthcare Provider Details

I. General information

NPI: 1659890218
Provider Name (Legal Business Name): INDIANA NEUROLOGY AND PAIN CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2017
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 N SHADELAND AVE STE 1A
INDIANAPOLIS IN
46250-2877
US

IV. Provider business mailing address

7301 N SHADELAND AVE STE 1A
INDIANAPOLIS IN
46250-2877
US

V. Phone/Fax

Practice location:
  • Phone: 317-939-6100
  • Fax:
Mailing address:
  • Phone: 317-939-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number01067436A
License Number StateIN

VIII. Authorized Official

Name: SAMIULLAH KUNDI
Title or Position: SOLE MEMBER
Credential: MD
Phone: 317-939-6100