Provider Demographics
NPI:1366984288
Name:KATERYNA KOMAROVSKIY, MD, PLLC
Entity type:Organization
Organization Name:KATERYNA KOMAROVSKIY, MD, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATERYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOMAROVSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-755-4238
Mailing Address - Street 1:150 PINE FOREST DR #103
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384
Mailing Address - Country:US
Mailing Address - Phone:936-755-4238
Mailing Address - Fax:936-755-5979
Practice Address - Street 1:150 PINE FOREST DR # 103
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-5302
Practice Address - Country:US
Practice Address - Phone:936-755-4238
Practice Address - Fax:936-755-5979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-09
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX350299901Medicaid