Provider Demographics
NPI:1407115181
Name:KOMAKULA, VENUGOPAL (MD)
Entity Type:Individual
Prefix:MR
First Name:VENUGOPAL
Middle Name:
Last Name:KOMAKULA
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 1:2830 VICTORY PKWY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1785
Mailing Address - Country:US
Mailing Address - Phone:513-245-3072
Mailing Address - Fax:513-585-5511
Practice Address - Street 1:7798 DISCOVERY DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-7745
Practice Address - Country:US
Practice Address - Phone:513-475-7500
Practice Address - Fax:513-475-7501
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD176686207QS1201X, 207QS1201X
OH35139972207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine