Physician Compare National (NPI:1124297213)

HEALTHCARE PROVIDER: GEORGE V KOMARIDIS PH.D.. LP

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1124297213
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7719124544
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20130515000189
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KOMARIDIS
	Individual professional last name
Provider First Name	GEORGE
	Individual professional first name
Provider Middle Name	V
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF NEBRASKA COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1969
	Individual professional's medical school graduation year
Primary Specialty	PSYCHOLOGIST, CLINICAL
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	12 CIVIC CTR PLZ
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 1615
	Group Practice or individual's line 2 address
City	MANKATO
	Group Practice or individual's city
State	MN
	Group Practice or individual's state
Zip Code	560017783
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y