Healthcare Provider Details

I. General information

NPI: 1427343490
Provider Name (Legal Business Name): CHRISTOPHER W. KOMUREK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2011
Last Update Date: 07/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 KNIGHTS RD
PHILADELPHIA PA
19114-4200
US

IV. Provider business mailing address

10800 KNIGHTS RD
PHILADELPHIA PA
19114-4200
US

V. Phone/Fax

Practice location:
  • Phone: 215-612-4963
  • Fax: 215-612-4532
Mailing address:
  • Phone: 215-612-4963
  • Fax: 215-612-4532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS016439
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: