Provider Demographics
NPI:1043948433
Name:KOMAL. V, LLC
Entity Type:Organization
Organization Name:KOMAL. V, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KOMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEGHAT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:662-617-2623
Mailing Address - Street 1:6446 EVERGREEN PARK DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-3919
Mailing Address - Country:US
Mailing Address - Phone:662-617-2623
Mailing Address - Fax:
Practice Address - Street 1:6446 EVERGREEN PARK DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-3919
Practice Address - Country:US
Practice Address - Phone:662-617-2623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service