MEDICARE: DR. STEPHEN JEREMY KOMINSKY D.P.M.

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	213ES0103X	Foot & Ankle Surgery Podiatrist	01800	MD
2	213E00000X	Podiatrist	01800	MD

General Provider Information

NPI Number	:	1992706808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN JEREMY KOMINSKY D.P.M.

Provider Business Mailing Address
First Line	:	2525 W GREENWAY RD STE 300
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85023-4292
Country	:	US
Telephone Number	:	480-573-0130
Fax Number	:	480-573-0131

Provider Business Practice Location Address
First Line	:	2525 W GREENWAY RD STE 2440
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85023-4226
Country	:	US
Telephone Number	:	480-573-0130
Fax Number	:	480-573-0131

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	04/14/2026

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