Healthcare Provider Details

I. General information

NPI: 1912426461
Provider Name (Legal Business Name): INDIANA NEUROLOGY AND PAIN CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2017
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6920 PARKDALE PLACE SUITE 215
INDIANAPOLIS IN
46254
US

IV. Provider business mailing address

6920 PARKDALE PL STE 215
INDIANAPOLIS IN
46254-5611
US

V. Phone/Fax

Practice location:
  • Phone: 405-408-6154
  • 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 K KUNDI
Title or Position: SOLE MEMBER
Credential: MD
Phone: 317-939-6100