Joseph Kundukulam (NPI# 1871938670, PAC ID# 0749597219) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PAIN MANAGEMENT.
| Nation Provider ID (NPI) | 1871938670 |
| PAC ID by PECOS | 0749597219 |
| Professional Enrollment ID | I20190212002183 |
| Full Name | Joseph Kundukulam |
| Organization Legal Name | WAKE SPINE AND PAIN SPECIALISTS, PC |
| Address |
958 Vandora Springs Rd Garner NC 27529-3544 |
| Phone Number | 9197877246 |
| Gender | M |
| Medical School | UNIVERSITY OF ALABAMA SCHOOL OF MEDICINE |
| Graduation Year | 2013 |
| Primary Specialty | PAIN MANAGEMENT |
| Group Practice PAC ID | 2860543097 |
| Number of Group Practice Members | 12 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 340069 | WAKEMED, RALEIGH CAMPUS |
| Address | Phone | Organization |
|---|---|---|
| 958 Vandora Springs Rd, Garner, NC 27529-3544 | 9197877246 | WAKE SPINE AND PAIN SPECIALISTS, PC |
| 3801 Wake Forest Rd, Suite 210, Raleigh, NC 27609-6864 | 9197877246 | WAKE SPINE AND PAIN SPECIALISTS, PC |
| Organization Legal Name | WAKE SPINE AND PAIN SPECIALISTS, PC |
| Physicians | 12 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Kristina Bullock | Physician Assistant | Wake Spine and Pain Specialists, PC | 958 Vandora Springs Rd, Garner, NC 27529-3544 |
| Shannon Dorothea Vassallo | Physician Assistant | Wake Spine and Pain Specialists, PC | 958 Vandora Springs Rd, Garner, NC 27529-3544 |
| Brian Phillip Hertzberg | Anesthesiology | Wake Spine and Pain Specialists, PC | 3801 Wake Forest Rd, Suite 210, Raleigh, NC 27609-6864 |
| Mark Reznik | Physical Medicine and Rehabilitation | Wake Spine and Pain Specialists, PC | 3801 Wake Forest Rd, Suite 210, Raleigh, NC 27609-6864 |
| Colleen M Pawlak | Nurse Practitioner | Wake Spine and Pain Specialists, PC | 3801 Wake Forest Rd, Suite 210, Raleigh, NC 27609-6864 |
| Himanshu R Kenjale | Physician Assistant | Wake Spine and Pain Specialists, PC | 958 Vandora Springs Rd, Garner, NC 27529-3544 |
| Anthony Robinson | Physician Assistant | Wake Spine and Pain Specialists, PC | 958 Vandora Springs Rd, Garner, NC 27529-3544 |
| Timothy Reis | Pain Management | Wake Spine and Pain Specialists, PC | 3801 Wake Forest Rd, Suite 210, Raleigh, NC 27609-6864 |
| Theresa A Steimle | Physician Assistant | Wake Spine and Pain Specialists, PC | 958 Vandora Springs Rd, Garner, NC 27529-3544 |
| Vijaysinha A Mandhare | Anesthesiology | Wake Spine and Pain Specialists, PC | 3801 Wake Forest Rd, Suite 210, Raleigh, NC 27609-6864 |
| Street Address |
958 VANDORA SPRINGS RD |
| City | GARNER |
| State | NC |
| Zip | 27529-3544 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Kristina Bullock | Physician Assistant | Wake Spine and Pain Specialists, PC | 958 Vandora Springs Rd, Garner, NC 27529-3544 |
| Shannon Dorothea Vassallo | Physician Assistant | Wake Spine and Pain Specialists, PC | 958 Vandora Springs Rd, Garner, NC 27529-3544 |
| Himanshu R Kenjale | Physician Assistant | Wake Spine and Pain Specialists, PC | 958 Vandora Springs Rd, Garner, NC 27529-3544 |
| Anthony Robinson | Physician Assistant | Wake Spine and Pain Specialists, PC | 958 Vandora Springs Rd, Garner, NC 27529-3544 |
| Theresa A Steimle | Physician Assistant | Wake Spine and Pain Specialists, PC | 958 Vandora Springs Rd, Garner, NC 27529-3544 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Marlo R Watson | Clinical Social Worker | 5533 Hwy 42 W, Unit 4a 4, Garner, NC 27529 | |
| Michael F Soboeiro | Internal Medicine | Wake Specialty Physicians LLC | 400 Us Hwy 70 E, Garner, NC 27529 |
| William J Jackson | Chiropractic | 260 Hwy 70w, Garner, NC 27529 | |
| Jodi Lynn Miller | Family Medicine | Wake Specialty Physicians LLC | 400 Us Hwy 70 E, Garner, NC 27529 |
| Humayun M Kadir | Family Medicine | Wake Specialty Physicians LLC | 400 Us Hwy 70 E, Garner, NC 27529 |
| Anomis D Dula | Audiologist | Wake Specialty Physicians LLC | 400 Us Hwy 70 E, Garner, NC 27529 |
| Catherine S Glazer | Emergency Medicine | Wakemed Specialists Group, LLC | 811 Us 70 Hwy W, Garner, NC 27529-2541 |
| Patrick Wayne Donahue | Family Medicine | Wakemed Specialists Group, LLC | 811 Us 70 Hwy W, Garner, NC 27529-2541 |
| Hannah E Boghosian | Physician Assistant | Rex Hospital Inc | 1165 Us Hwy 70 W, Garner, NC 27529-2547 |
| Alexandra Kilraine Kaznowski | Physician Assistant | Rex Hospital Inc | 1165 Us Hwy 70 W, Garner, NC 27529-2547 |
| Find all physicians in zip 27529 | |||
| City | GARNER |
| Zip Code | 27529 |
| Specialty | PAIN MANAGEMENT |
| City + Specialty | GARNER + PAIN MANAGEMENT |
Please comment or provide details below to improve the information on Joseph Kundukulam.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.