Provider Demographics
NPI:1851380752
Name:COMNICK, MARK BRIAN OLMSCHEID (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:BRIAN OLMSCHEID
Last Name:COMNICK
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 1:5200 FAIRVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MN
Mailing Address - Zip Code:55092-8013
Mailing Address - Country:US
Mailing Address - Phone:651-982-7000
Mailing Address - Fax:
Practice Address - Street 1:5200 FAIRVIEW BLVD
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MN
Practice Address - Zip Code:55092-8013
Practice Address - Country:US
Practice Address - Phone:651-982-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN44941207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0406676OtherMEDICA HEALTH PLANS
143209OtherUCARE
2121656OtherARAZ GROUP AMERICAS PPO
81604OtherCHAMPUS
HP42375OtherHEALTH PARTNERS
1041077OtherPREFERRED ONE
MN882927600Medicaid
842S4COOtherBLUE CROSS BLUE SHIELD
81604OtherFIRST HEALTH PLAN
882927600OtherMEDICAL ASSISTANCE
92204OtherONE HEALTH PLAN GREAT WES
EFF52704OtherMMSI
2121656OtherARAZ GROUP AMERICAS PPO
EFF52704OtherMMSI
1041077OtherPREFERRED ONE