MEDICARE: DR. REVATI KOMANDUR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	9601650	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023012358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REVATI KOMANDUR MD

Provider Business Mailing Address
First Line	:	PSC 10 BOX 1265
Second Line	:
City	:	APO
State	:	AE
Zip	:	09142-0013
Country	:	US
Telephone Number	:	314-590-7351
Fax Number	:

Provider Business Practice Location Address
First Line	:	LANDSTUHL REGIONAL MEDICAL CENTER
Second Line	:	UNIT 33100
City	:	APO
State	:	AE
Zip	:	09180
Country	:	US
Telephone Number	:	314-590-7351
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	03/08/2023

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