Provider Demographics
NPI:1386910131
Name:KOMRAD, EUGENE LESLIE (MD)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:LESLIE
Last Name:KOMRAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:EUGENE
Other - Middle Name:LESLIE
Other - Last Name:KOMRAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:600 BILTMORE WAY PH 109
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-7535
Mailing Address - Country:US
Mailing Address - Phone:305-443-1448
Mailing Address - Fax:305-442-6071
Practice Address - Street 1:600 BILTMORE WAY PH 109
Practice Address - Street 2:PH109
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-7535
Practice Address - Country:US
Practice Address - Phone:305-443-1448
Practice Address - Fax:305-442-6071
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME12335305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service