Provider Demographics
NPI:1902844798
Name:ADVANCED PAIN CONSULTANTS
Entity Type:Organization
Organization Name:ADVANCED PAIN CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:KANURU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-838-1100
Mailing Address - Street 1:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46325-0608
Mailing Address - Country:US
Mailing Address - Phone:219-838-1100
Mailing Address - Fax:
Practice Address - Street 1:3449 RIDGE RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-2049
Practice Address - Country:US
Practice Address - Phone:219-838-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty