Provider Demographics
NPI:1386673176
Name:EL KOMMOS, HANI H (MD)
Entity Type:Individual
Prefix:DR
First Name:HANI
Middle Name:H
Last Name:EL KOMMOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 N SYKES CREEK PKWY
Mailing Address - Street 2:#200
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-3490
Mailing Address - Country:US
Mailing Address - Phone:321-459-1446
Mailing Address - Fax:321-452-1261
Practice Address - Street 1:220 N SYKES CREEK PKWY
Practice Address - Street 2:#200
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-3490
Practice Address - Country:US
Practice Address - Phone:321-459-1446
Practice Address - Fax:321-452-1261
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59543207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA83024Medicare UPIN
FL11988ZMedicare ID - Type Unspecified