Provider Demographics
NPI:1881690527
Name:PINNAMANENI, NIRMALA (MD)
Entity Type:Individual
Prefix:
First Name:NIRMALA
Middle Name:
Last Name:PINNAMANENI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9307 CALUMET AVE
Mailing Address - Street 2:STE A2
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2892
Mailing Address - Country:US
Mailing Address - Phone:219-836-2274
Mailing Address - Fax:219-836-4200
Practice Address - Street 1:9307 CALUMET AVE
Practice Address - Street 2:STE A2
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2892
Practice Address - Country:US
Practice Address - Phone:219-836-2274
Practice Address - Fax:219-836-4200
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027916A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000215414OtherBLUE CROSS BLUE SHIELD
IL0091107872OtherBCBS ILLINOIS
000000215414OtherBLUE CROSS BLUE SHIELD
IL0091107872OtherBCBS ILLINOIS