Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0202X | Pediatric Cardiologist | 252248 | MA |
Y | 2080P0202X | Pediatric Cardiologist | 35.123305 | OH |
NPI | 1023323532 |
---|---|
Provider Name | Rukmini R Komarlu |
First Address | Cleveland, OH 44195-5724 |
Second Address | Cleveland, OH 44195-5724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2010 |
Last Update Date | 18/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01068597A | INDIANA LICENSE (01) | IN |