Provider Demographics
NPI:1841236833
Name:KOMMAREDDI, SITARA (MD)
Entity Type:Individual
Prefix:DR
First Name:SITARA
Middle Name:
Last Name:KOMMAREDDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6567 E CARONDELET DR
Mailing Address - Street 2:SUITE 435
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-6152
Mailing Address - Country:US
Mailing Address - Phone:520-512-5757
Mailing Address - Fax:520-882-3211
Practice Address - Street 1:6567 E CARONDELET DR
Practice Address - Street 2:SUITE 435
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-6152
Practice Address - Country:US
Practice Address - Phone:520-512-5757
Practice Address - Fax:520-882-3211
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ31411208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ31411OtherSTATE LICENSE
AZ778673Medicaid