Provider Demographics
NPI:1265478697
Name:KOMINSKY, ANDREW LEWIS (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:LEWIS
Last Name:KOMINSKY
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 1:3815 N SCHREIBER WAY UNIT 101
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-8434
Mailing Address - Country:US
Mailing Address - Phone:208-755-2804
Mailing Address - Fax:208-765-0277
Practice Address - Street 1:3815 N SCHREIBER WAY UNIT 101
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-8434
Practice Address - Country:US
Practice Address - Phone:208-755-2804
Practice Address - Fax:208-765-0277
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID2061972207RH0000X, 207RH0003X
WAMD00046940207RH0000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7297797OtherAETNA
WA0236212OtherL&I AND CRIME VICTIMS
WA4465KOOtherREGENCE
WA1265478697Medicaid
WA7297797OtherAETNA
WAH37759Medicare UPIN