Active NPI
Nancy Kominiarek, PA
- Physician Assistant
- Saint Clair Shores, MI
National Provider Identifier
1629024666
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 5601004536
- Practice address
- 25311 Little Mack Ave
Suite B
Saint Clair Shores, MI 48081-3301 - Phone
- (586) 498-2400
- Fax
- (586) 498-2800
- NPI assigned
- May 25, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5601004536 | MI | Primary |
Addresses
Primary practice location
25311 Little Mack Ave
Suite B
Saint Clair Shores, MI 48081-3301
Mailing address
25311 Little Mack
Suite B
St. Clair Shores, MI 48081
Phone (586) 498-2400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1233619200000",
"number": "1629024666",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25311 LITTLE MACK",
"address_2": "SUITE B",
"city": "ST. CLAIR SHORES",
"state": "MI",
"postal_code": "48081",
"telephone_number": "586-498-2400",
"fax_number": "586-498-2800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25311 LITTLE MACK AVE",
"address_2": "SUITE B",
"city": "SAINT CLAIR SHORES",
"state": "MI",
"postal_code": "480813301",
"telephone_number": "586-498-2400",
"fax_number": "586-498-2800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOMINIAREK",
"first_name": "NANCY",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-25",
"last_updated": "2009-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MI",
"license": "5601004536",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Clair Shores, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.