Organization
MK ORTHOPEDICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MUKUND KOMANDURI MD (PRESIDENT/OWNER)
(630) 330-9596
Entity
Organization
Contact information
Practice address
11360 BROADWAY, CROWN POINT, IN 46307-7197
(630) 330-9596
Mailing address
11360 BROADWAY, CROWN POINT, IN 46307-7197
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IN4530
INDIANA MEDICARE
IN
Enumeration date
02/27/2020
Last updated
07/09/2020
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