Provider Demographics
NPI:1023323532
Name:KOMARLU, RUKMINI R (MD)
Entity type:Individual
Prefix:
First Name:RUKMINI
Middle Name:R
Last Name:KOMARLU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-5724
Mailing Address - Country:US
Mailing Address - Phone:216-386-4015
Mailing Address - Fax:216-445-3692
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-5724
Practice Address - Country:US
Practice Address - Phone:216-444-0450
Practice Address - Fax:216-445-3692
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2522482080P0202X
OH35.1233052080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01068597AOtherINDIANA LICENSE