Healthcare Provider Details

I. General information

NPI: 1235865759
Provider Name (Legal Business Name): SAI SUBRAMANYAM KOMMINENI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 NE 13TH ST
OKLAHOMA CITY OK
73104-5004
US

IV. Provider business mailing address

75 READI MIX SPUR APT 13
HARLAN KY
40831-3549
US

V. Phone/Fax

Practice location:
  • Phone: 606-595-8580
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number45527
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number62072
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: