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General NPI Number Information
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NPI Number | 1639386089
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Entity Type | Organization
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Legal Business Name | ROBERT A KOMINIAREK DO INC
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 04/20/2010
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Provider Practice Location Address
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Address Line | 450 B WASHINGTON JACKSON RD SUITE106
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City | EATON
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State | OH
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Zip | 45320
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Country | US
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Telephone | 937-456-8370
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Fax |
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Provider Business Mailing Address
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Address Line | 450 B WASHINGTON JACKSON RD SUITE106
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City | EATON
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State | OH
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Zip | 45320
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Country | US
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Telephone | 937-456-8370
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT A KOMINIAREK
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Credential | D.O.
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Telephone | 937-456-8370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 34006547
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License Number State | OH
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