Provider Demographics
NPI:1659890218
Name:INDIANA NEUROLOGY AND PAIN CENTER LLC
Entity Type:Organization
Organization Name:INDIANA NEUROLOGY AND PAIN CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SAMIULLAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-939-6100
Mailing Address - Street 1:7301 N SHADELAND AVE STE 1A
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2877
Mailing Address - Country:US
Mailing Address - Phone:317-939-6100
Mailing Address - Fax:
Practice Address - Street 1:7301 N SHADELAND AVE STE 1A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2877
Practice Address - Country:US
Practice Address - Phone:317-939-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-14
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01067436A2084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Multi-Specialty