Individual
TIMOTHY S KOMOTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 BUNKER HILL DR, AITKIN, MN 56431-1865
(218) 927-2157
(218) 927-4130
Mailing address
200 BUNKER HILL DR, AITKIN, MN 56431-1865
(218) 927-2157
(218) 927-4130
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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