Provider Demographics
NPI:1306839006
Name:KOMOZEC, PERO (MD)
Entity Type:Individual
Prefix:DR
First Name:PERO
Middle Name:
Last Name:KOMOZEC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2745 W LAYTON AVENUE
Mailing Address - Street 2:SUITE G30
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-2651
Mailing Address - Country:US
Mailing Address - Phone:414-389-3086
Mailing Address - Fax:414-755-8256
Practice Address - Street 1:2745 W LAYTON AVENUE
Practice Address - Street 2:SUITE 206
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53221-2651
Practice Address - Country:US
Practice Address - Phone:414-389-3086
Practice Address - Fax:414-755-8256
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33082207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32016800Medicaid
WI002402475Medicare ID - Type Unspecified
WI32016800Medicaid