Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 036143512 | IL |
NPI | 1003159153 |
---|---|
Provider Name | Matthew Scott Kominsky |
First Address | Evanston, IL 60201-1700 |
Second Address | Chicago, IL 60625-3661 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2013 |
Last Update Date | 13/09/2021 |