MEDICARE: DR. VIJAYA K KOMMAREDDI 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	4301089295	MI

General Provider Information

NPI Number	:	1679772891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIJAYA K KOMMAREDDI MD

Provider Business Mailing Address
First Line	:	3701 LOOP ROAD SUITE 210
Second Line	:	VA MEDICAL CENTER
City	:	TUSCALOOSA
State	:	AL
Zip	:	35405-4998
Country	:	US
Telephone Number	:	205-554-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3701 LOOP ROAD SUITE 210
Second Line	:	VA MEDICAL CENTER
City	:	TUSCALOOSA
State	:	AL
Zip	:	35405
Country	:	US
Telephone Number	:	205-554-2000
Fax Number	:

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

Provider Enumeration Date	:	07/17/2007
Last Update Date	:	11/17/2011

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