Provider Demographics
NPI:1235616541
Name:KOMAL, UNKNOWN
Entity Type:Individual
Prefix:
First Name:UNKNOWN
Middle Name:
Last Name:KOMAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 FRUITVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-6223
Mailing Address - Country:US
Mailing Address - Phone:941-365-0333
Mailing Address - Fax:941-955-3181
Practice Address - Street 1:2400 FRUITVILLE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-6223
Practice Address - Country:US
Practice Address - Phone:941-365-0333
Practice Address - Fax:941-955-3181
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-20
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11393600207R00000X, 207RE0101X
FLME162750207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME162750OtherSTATE LICENSE NUMBER