Healthcare Provider Details

I. General information

NPI: 1760477657
Provider Name (Legal Business Name): FREDERICK C KOMINARS P.A.-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 ELLIOTT DR
YPSILANTI MI
48197-8632
US

IV. Provider business mailing address

5300 ELLIOTT DR
YPSILANTI MI
48197-8632
US

V. Phone/Fax

Practice location:
  • Phone: 734-434-6262
  • Fax: 713-712-2820
Mailing address:
  • Phone: 734-434-6262
  • Fax: 734-712-2820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberFK002395
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: