Healthcare Provider Details

I. General information

NPI: 1992706808
Provider Name (Legal Business Name): STEPHEN JEREMY KOMINSKY D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 W GREENWAY RD STE 2440
PHOENIX AZ
85023-4226
US

IV. Provider business mailing address

2525 W GREENWAY RD STE 300
PHOENIX AZ
85023-4292
US

V. Phone/Fax

Practice location:
  • Phone: 480-573-0130
  • Fax: 480-573-0131
Mailing address:
  • Phone: 480-573-0130
  • Fax: 480-573-0131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number01800
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number01800
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: