Provider Demographics
NPI:1417132820
Name:BRIAN KOMM DPM PC
Entity Type:Organization
Organization Name:BRIAN KOMM DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:KOMM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:406-723-7990
Mailing Address - Street 1:3215 OTTAWA ST
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-6539
Mailing Address - Country:US
Mailing Address - Phone:406-723-7990
Mailing Address - Fax:406-723-0080
Practice Address - Street 1:3215 OTTAWA ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-6539
Practice Address - Country:US
Practice Address - Phone:406-723-7990
Practice Address - Fax:406-723-0080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT147213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT018841OtherBCBS
MT0000390558Medicaid
MTU75457Medicare UPIN
MT0000390558Medicaid