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General NPI Number Information
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NPI Number | 1750614970
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Entity Type | Organization
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Legal Business Name | NORTHERN IOWA PAIN MANAGEMENT, PC
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Dates
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Enumeration Date | 09/08/2009
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Last Update Date | 09/08/2009
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Provider Practice Location Address
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Address Line | 2710 SAINT FRANCIS DR SUITE 202
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City | WATERLOO
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State | IA
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Zip | 50702-5619
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Country | US
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Telephone | 319-272-3323
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Fax | 319-272-3320
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Provider Business Mailing Address
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Address Line | PO BOX 2400
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City | WATERLOO
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State | IA
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Zip | 50704-2400
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Country | US
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Telephone | 319-233-3044
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Fax | 319-233-0722
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Authorized Official
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Title or Position | OWNER
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Name | GAYATHRY MURTHY INAMDAR
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Credential | MD
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Telephone | 319-233-3044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 33957
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License Number State | IA
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