Healthcare Provider Details

I. General information

NPI: 1437104858
Provider Name (Legal Business Name): MICHAEL L. KOMIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 06/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 E LERDO HWY #C
SHAFTER CA
93263-9417
US

IV. Provider business mailing address

1150 E LERDO HWY # C
SHAFTER CA
93263-9417
US

V. Phone/Fax

Practice location:
  • Phone: 661-630-5890
  • Fax: 661-630-5896
Mailing address:
  • Phone: 661-630-5890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA76214
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: