Provider Demographics
NPI:1447527817
Name:SITARA KOMMAREDDI MD PLLC
Entity type:Organization
Organization Name:SITARA KOMMAREDDI MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SITARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOMMAREDDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-512-5757
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-29
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ150498Medicare PIN