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General NPI Number Information
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NPI Number | 1568771095
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Entity Type | Organization
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Legal Business Name | KOKOMO PAIN MANAGEMENT, LLC
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Dates
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Enumeration Date | 10/01/2010
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Last Update Date | 08/23/2024
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Provider Practice Location Address
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Address Line | 18077 RIVER RD STE 200
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City | NOBLESVILLE
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State | IN
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Zip | 46062-8334
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Country | US
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Telephone | 317-776-7028
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Fax | 317-773-7910
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Provider Business Mailing Address
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Address Line | 18077 RIVER RD STE 200
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City | NOBLESVILLE
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State | IN
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Zip | 46062-8334
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Country | US
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Telephone | 317-776-7028
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Fax | 317-773-7910
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN PETER KLIM
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Credential | DO
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Telephone | 317-776-7028
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | 02002790A
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License Number State | IN
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