Provider Demographics
NPI:1407935042
Name:KOMOROWSKI, MARK C (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:C
Last Name:KOMOROWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:610 S TRUMBULL STREET
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708
Mailing Address - Country:US
Mailing Address - Phone:989-893-9393
Mailing Address - Fax:989-893-9975
Practice Address - Street 1:610 S TRUMBULL STREET
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708
Practice Address - Country:US
Practice Address - Phone:989-893-9393
Practice Address - Fax:989-893-9975
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIMK050674208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI295089810Medicaid
MI0980939OtherHEALTH PLUS
MI2400900501OtherBLUE CROSS
F61999Medicare UPIN