Provider Demographics
NPI:1356573778
Name:NORTHWEST INDIANA PAIN SERVICES
Entity type:Organization
Organization Name:NORTHWEST INDIANA PAIN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNEELA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARSOOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD CIME
Authorized Official - Phone:630-887-9204
Mailing Address - Street 1:PO BOX 3307
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60522-3307
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 RIDGE RD
Practice Address - Street 2:SUITE # 3
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1574
Practice Address - Country:US
Practice Address - Phone:630-887-9204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060042A207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty