Provider Demographics
NPI:1194894519
Name:KOMANAPALLI, CHRISTOPHER BERNARD (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:BERNARD
Last Name:KOMANAPALLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 E RIVER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-5843
Mailing Address - Country:US
Mailing Address - Phone:515-875-9925
Mailing Address - Fax:520-838-2348
Practice Address - Street 1:2404 E RIVER RD STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-6521
Practice Address - Country:US
Practice Address - Phone:520-838-3540
Practice Address - Fax:520-325-3526
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-40188208G00000X
ORMD26610390200000X
MN52474208600000X, 208G00000X
IA40188208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1194894519Medicaid
AZ59976OtherARIZONA MEDICAL LICENSE