DR. PRASANTH NUTHAKKI (NPI# 1114046455) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114046455 |
| Entity Type | Individual |
| Full Name | DR. PRASANTH NUTHAKKI |
| Credential | MD |
| Practice Address |
24 Joliet St Dyer IN 46311-1705 |
| Mailing Address |
Po Box 3039 Munster IN 46321-0039 |
| Practice Telephone | 2198642237 |
| Mailing Telephone | 9379854010 |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2020-02-02 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 204C00000X | Neuromusculoskeletal Medicine, Sports Medicine | 01071908A | IN | Allopathic & Osteopathic Physicians |
| N | 208100000X | Physical Medicine & Rehabilitation | 01071908A | IN | Allopathic & Osteopathic Physicians |
| Y | 208VP0014X |
Pain Medicine Specialization: Interventional Pain Medicine |
01071908A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 201134860 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 759 45th Ave, Suite 201, Munster, IN 463212938 | 2198360296 | 2198360570 |
| Street Address |
24 JOLIET ST |
| City | DYER |
| State | IN |
| Zip Code | 46311-1705 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972595361 | Harvey Joseph Levin | Surgery | 24 Joliet St, Ste101, Dyer, IN 46311-1705 | 2005-08-22 |
| 1528687274 | Joshua Alexander Mclaughlin | Student in an Organized Health Care Education/Training Program | 24 Joliet St, Dyer, IN 46311-1705 | 2020-04-13 |
| 1225689169 | Kayla Marie Ranek | Surgery | 24 Joliet St, Dyer, IN 46311-1705 | 2019-09-23 |
| 1689221061 | Lindsey Marie Kolakoski | Registered Nurse | 24 Joliet St, Dyer, IN 46311-1705 | 2019-08-21 |
| 1588225320 | Mindy Ruan | Registered Nurse | 24 Joliet St, Dyer, IN 46311-1705 | 2019-06-24 |
| 1568021434 | Lindsey Marie Kilsdonk | Registered Nurse | 24 Joliet St, Dyer, IN 46311-1705 | 2019-06-13 |
| 1457919292 | Aja Simone Rivera | Registered Nurse | 24 Joliet St, Dyer, IN 46311-1705 | 2019-06-05 |
| 1104387521 | Interventional Spine and Joint Specialists, LLC | Electrodiagnostic Medicine | 24 Joliet St, Dyer, IN 46311-1705 | 2019-03-28 |
| 1841751526 | Artinder Preet Nanrhe | Student in an Organized Health Care Education/Training Program | 24 Joliet St, Dyer, IN 46311-1705 | 2019-03-26 |
| 1306311865 | Joan Levesque | Counselor | 24 Joliet St, Dyer, IN 46311-1705 | 2018-10-10 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407338858 | Leena Yousef-diaz | Nurse Practitioner | 1100 Joliet Street Suite #201, Dyer, IN 46311 | 2018-09-02 |
| 1518476639 | Kor Speech Therapy, LLC | Speech-Language Pathologist | 219 Primrose Dr., Dyer, IN 46311 | 2017-09-20 |
| 1861921207 | Derrick Durrah | Counselor | 2615 James Drive, Dyer, IN 46311 | 2017-06-08 |
| 1073962189 | Maria Lule | Pharmacist | 805 Joliet Road, Dyer, IN 46311 | 2016-06-09 |
| 1780072157 | Mario Munoz | Skilled Nursing Facility | 515 Audrey Ct, Dyer, IN 46311 | 2015-01-07 |
| 1457772451 | Lisa Jennifer Mickelson | Registered Nurse | 600 Joliet St., Kahler Middle School, Dyer, IN 46311 | 2013-12-18 |
| 1285055285 | Tanya D Burk-willson | Registered Nurse | 14600 W 81st St., Bibich Elementary, Dyer, IN 46311 | 2013-12-18 |
| 1013338011 | Mary Beth Rinaldi | Registered Nurse | 1121 Harrison Ave, Protsman Elementary, Dyer, IN 46311 | 2013-12-18 |
| 1023448057 | Franciscan Alliance | General Acute Care Hospital | 24 Joliet Street, 3da, Dyer, IN 46311 | 2013-11-12 |
| 1508078239 | Fatima Jaffer Md Sc PC | Internal Medicine | Physicians Pavilion Suite 101, 24 East Joliet Street, Dyer, IN 46311 | 2007-05-04 |
| Find all providers in zip 46311 | ||||
| Taxonomy Code | 208VP0014X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pain Medicine |
| Specialization | Interventional Pain Medicine |
| Interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578176087 | Pg Pro LLC | Pain Medicine | 4715 Statesmen Dr Ste Ab, Indianapolis, IN 46250-5642 | 2020-08-25 |
| 1942818109 | Advanced Pain Treatment of Chicago Sc | Pain Medicine | 1950 45th St Ste 101, Munster, IN 46321-3958 | 2020-07-14 |
| 1871050781 | Pain Management Solution LLC | Pain Medicine | 4010 W Goeller Blvd Ste C, Columbus, IN 47201-8312 | 2019-02-27 |
| 1841764495 | Pain Management Centers of America, Psc | Pain Medicine | 1717 S State Road 57 Ste F, Washington, IN 47501-4179 | 2019-01-16 |
| 1982185641 | Midwest Pain Institute Center for Minimally Invasive Spine PC | Pain Medicine | 7301 N Shadeland Ave Ste 1a, Indianapolis, IN 46250-2085 | 2018-08-22 |
| 1679088405 | Advanced Pain Care Clinic Psc | Pain Medicine | 5320 Weston Rd, Evansville, IN 47712-3701 | 2017-12-01 |
| 1730612698 | Advanced Pain Care Clinic Psc | Pain Medicine | 1813 Willow St Ste 3b, Vincennes, IN 47591 | 2017-04-07 |
| 1366987513 | Gary Gettelfinger Md Dabpm LLC | Pain Medicine | 1619 N Prairie Green Ct, Bloomington, IN 47408-8701 | 2016-12-27 |
| 1053785774 | Michael P Royalty Md LLC | Pain Medicine | 4888 Lost Lake Ct, Boonville, IN 47601 | 2015-11-18 |
| 1801938642 | Michael G. Cassaro, Md, Psc | Pain Medicine | 200 Missouri Ave, Suite B, Jeffersonville, IN 47130-3061 | 2007-02-12 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.