Healthcare Provider Details

I. General information

NPI: 1386053437
Provider Name (Legal Business Name): ISSEI KOMATSU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2014
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9104 BABCOCK BLVD SUITE 5113
PITTSBURGH PA
15237-5818
US

IV. Provider business mailing address

2 HOT METAL ST QUANTUM ONE, SUITE 001
PITTSBURGH PA
15203-2348
US

V. Phone/Fax

Practice location:
  • Phone: 412-748-7444
  • Fax: 412-748-7452
Mailing address:
  • Phone: 412-432-5869
  • Fax: 412-432-5640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD61134797
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD451574
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: