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General NPI Number Information
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NPI Number | 1801903497
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Entity Type | Organization
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Legal Business Name | MUKUND KOMANDURI MD SC
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 10/07/2010
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Provider Practice Location Address
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Address Line | 963 N 129TH INFANTRY DR SUITE 100
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City | JOLIET
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State | IL
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Zip | 60435-8346
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Country | US
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Telephone | 815-741-6900
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Fax | 815-741-6907
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Provider Business Mailing Address
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Address Line | 963 N 129TH INFANTRY DR SUITE 100
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City | JOLIET
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State | IL
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Zip | 60435-8346
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Country | US
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Telephone | 815-741-6900
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Fax | 815-741-6907
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Authorized Official
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Title or Position | OWNER
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Name | DR. MUKUND KOMANDURI
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Credential | M.D.
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Telephone | 815-741-6900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 36084511
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License Number State | IL
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