Provider Demographics
NPI:1508953241
Name:KOMES, KEVEN D (MD)
Entity Type:Individual
Prefix:
First Name:KEVEN
Middle Name:D
Last Name:KOMES
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:PO BOX 7687
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7687
Mailing Address - Country:US
Mailing Address - Phone:573-882-2259
Mailing Address - Fax:
Practice Address - Street 1:1101 VIRGINIA AVENUE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:573-884-6642
Practice Address - Fax:573-884-3790
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-24580208100000X
MO101203208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS040481OtherBCBS KANSAS
MO203406806Medicaid
KS100134990DMedicaid
MO222466OtherHEALTHLINK
MO4294OtherBCBS MO
MOP00440877Medicare PIN
MO320442846Medicare PIN
F27952Medicare UPIN
MO012478Medicare ID - Type Unspecified
MO203406806Medicaid
MO222466OtherHEALTHLINK