MEDICARE: DR. DAVID A KOMJATHY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	4301080082	MI

General Provider Information

NPI Number	:	1346424256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID A KOMJATHY MD

Provider Business Mailing Address
First Line	:	400 HINCKLEY BLVD STE 300
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-6129
Country	:	US
Telephone Number	:	517-782-7415
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 HINCKLEY BLVD STE 300
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-6129
Country	:	US
Telephone Number	:	517-782-7415
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2007
Last Update Date	:	02/01/2026

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