Provider Demographics
NPI:1760477657
Name:KOMINARS, FREDERICK C (PA-C)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:C
Last Name:KOMINARS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 ELLIOTT DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-8632
Mailing Address - Country:US
Mailing Address - Phone:734-434-6262
Mailing Address - Fax:734-712-2820
Practice Address - Street 1:5300 ELLIOTT DR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-8632
Practice Address - Country:US
Practice Address - Phone:734-434-6262
Practice Address - Fax:713-712-2820
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIFK002395363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H14989OtherBCBS GROUP
MI1058112690OtherBCBS INDIVIDUAL
MI0H14989OtherBCBS GROUP
MIM86720015Medicare PIN
S57892Medicare UPIN