Provider Demographics
NPI:1821483157
Name:KOMMULA, NITA (MD)
Entity type:Individual
Prefix:
First Name:NITA
Middle Name:
Last Name:KOMMULA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8375 NW 53RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33166-4611
Mailing Address - Country:US
Mailing Address - Phone:305-243-1815
Mailing Address - Fax:
Practice Address - Street 1:8375 NW 53RD ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33166-4611
Practice Address - Country:US
Practice Address - Phone:305-243-1815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-03
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1715142085R0202X
VA01012682352085R0202X
TXT38082085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology