MEDICARE: DR. ANDREW LEWIS KOMINSKY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0000X	Hematology (Internal Medicine) Physician	2061972	ID
2	207RH0000X	Hematology (Internal Medicine) Physician	MD00046940	WA
3	207RX0202X	Medical Oncology Physician	MD00046940	WA
4	207RH0003X	Hematology & Oncology Physician	2061972	ID

General Provider Information

NPI Number	:	1265478697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW LEWIS KOMINSKY MD

Provider Business Mailing Address
First Line	:	3815 N SCHREIBER WAY UNIT 101
Second Line	:
City	:	COEUR D ALENE
State	:	ID
Zip	:	83815-8434
Country	:	US
Telephone Number	:	208-755-2804
Fax Number	:	208-765-0277

Provider Business Practice Location Address
First Line	:	3815 N SCHREIBER WAY UNIT 101
Second Line	:
City	:	COEUR D ALENE
State	:	ID
Zip	:	83815-8434
Country	:	US
Telephone Number	:	208-755-2804
Fax Number	:	208-765-0277

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	11/11/2024

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