Healthcare Provider Details

I. General information

NPI: 1417335845
Provider Name (Legal Business Name): RITESH KORUMILLI M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3186 S MARYLAND PKWY
LAS VEGAS NV
89109-2317
US

IV. Provider business mailing address

340 SE 3RD ST APT 3411
MIAMI FL
33131-1754
US

V. Phone/Fax

Practice location:
  • Phone: 702-961-5437
  • Fax:
Mailing address:
  • Phone: 914-356-1847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number20960
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number290068
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: