Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 01071908A | IN |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 01071908A | IN |
NPI | 1114046455 |
---|---|
Provider Name | Dr. Prasanth Nuthakki |
First Address | Munster, IN 46321-0039 |
Second Address | Munster, IN 46321-4038 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 01/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201134860 | (05) | IN |