Healthcare Provider Details

I. General information

NPI: 1902822737
Provider Name (Legal Business Name): MICHELLE A KOMINIAREK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 03/04/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N SAINT CLAIR ST GALTER, SUITE 14-200
CHICAGO IL
60611-5975
US

IV. Provider business mailing address

675 N SAINT CLAIR ST GALTER, SUITE 14-200
CHICAGO IL
60611-5975
US

V. Phone/Fax

Practice location:
  • Phone: 312-472-0531
  • Fax: 312-472-3740
Mailing address:
  • Phone: 312-472-0531
  • Fax: 312-472-3740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number036105885
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: