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Individual
TIMOTHY S KOMOTO
Active
Individual
TIMOTHY S KOMOTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
26655
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080015564
MEDICARE WPS - HOSPITAL
MN
01
—
080015565
MEDICARE WPS - AITKIN CLI
MN
01
—
080015566
MEDICARE WPS - MCGREGOR C
MN
01
—
080015846
MEDICARE WPS - GARRISON C
MN
05
—
411008100
—
MN
Enumeration date
11/21/2006
Last updated
11/05/2020
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