Individual
DR. CHRISTIAN ROBERT KOMOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
235 LOUIS ST NW, GRAND RAPIDS, MI 49503-2600
(616) 706-6951
Mailing address
428 CHILDERS ST, PMB 24256, PENSACOLA, FL 32534-9630
(616) 706-6951
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301005480
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M032644
CHAMPUS
MI
05
—
OD14598
—
MI
Enumeration date
10/15/2015
Last updated
09/14/2016
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