Healthcare Provider Details

I. General information

NPI: 1457303588
Provider Name (Legal Business Name): KELLY C KOMATZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 SUMMER AVE
JUPITER FL
33469-3119
US

IV. Provider business mailing address

1519 SUMMER AVE
JUPITER FL
33469-3119
US

V. Phone/Fax

Practice location:
  • Phone: 904-428-9197
  • Fax:
Mailing address:
  • Phone: 904-428-9197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME61036
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License NumberME61036
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: