Provider Demographics
NPI:1730163460
Name:KOMARAGIRI, DURGA (MD)
Entity type:Individual
Prefix:
First Name:DURGA
Middle Name:
Last Name:KOMARAGIRI
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 1:800 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-4575
Mailing Address - Country:US
Mailing Address - Phone:507-238-8555
Mailing Address - Fax:
Practice Address - Street 1:800 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-4575
Practice Address - Country:US
Practice Address - Phone:507-238-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN42671207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN24F27KOOtherBCBS
MNHP30764OtherHEALTH PARTNERS
MN04-05427OtherMEDICA
MN1033142OtherARAZ
MN150788Medicaid
IA528919Medicaid
MN24F27KOMedicaid
MN24F27KOOtherBCBS/MEDICARE SUPPLEMENT
FMA036OtherCHAMPUS
MNMH9041024628OtherPPO
MNP00194405Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MN24F27KOMedicaid