Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 036.135542 | IL |
N | 207V00000X | Obstetrician & Gynecologist | 73700 | WI |
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 036.135542 | IL |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 73700 | WI |
NPI | 1699086504 |
---|---|
Provider Name | Dr. Alix F Komar |
First Address | Milwaukee, WI 53215-2843 |
Second Address | West Allis, WI 53227-2409 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2010 |
Last Update Date | 02/12/2021 |