MK Orthopedics, LLC

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

Legal business name

MK ORTHOPEDICS, LLC

Practice address

11360 Broadway
Crown Point, IN 46307-7197

Phone

(630) 330-9596

NPI assigned

Feb 27, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mukund Komanduri, MD

Title

President/Owner

Phone

(630) 330-9596

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1582761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594252800000",
    "number": "1306470398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11360 BROADWAY",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463077197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11360 BROADWAY",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463077197",
            "telephone_number": "630-330-9596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MK ORTHOPEDICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-27",
        "last_updated": "2020-07-09",
        "certification_date": "2020-07-09",
        "status": "A",
        "authorized_official_last_name": "KOMANDURI",
        "authorized_official_first_name": "MUKUND",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "630-330-9596",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIANA MEDICARE",
            "identifier": "IN4530",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Mirro, PSYD
• Ryan Kilpatrick Misek, D.O.
• Mitchell Leslie Bressack
• Maranda Michelle Mitchell
• Rachelle Lene' Mitchell, PMHNP
• Jorie J. Moberley, PHD, CPNP
• Melissa Moeller, DPT
• Deanna Moes
• Nicole Moes, MA, BCBA
• Thanzeela Kausar Mohideen, M.D.

• Orthopaedic Surgery Physician in Crown Point, IN
• Providers in Crown Point, IN by specialty
• Orthopaedic Surgery Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.