Provider Demographics
NPI:1841389913
Name:KOMINIAREK, ROBERT A (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:KOMINIAREK
Suffix:
Gender:M
Credentials:DO
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 305
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-0305
Mailing Address - Country:US
Mailing Address - Phone:937-456-8370
Mailing Address - Fax:937-456-8371
Practice Address - Street 1:450 B WASHINGTON JACKSON RD
Practice Address - Street 2:SUITE 106
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320
Practice Address - Country:US
Practice Address - Phone:937-456-8370
Practice Address - Fax:937-456-8371
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006547207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2065572Medicaid
431957177OtherTAX ID
OHG76479Medicare UPIN
OH2065572Medicaid
OHKO0853604Medicare PIN