KOMIVI WOMITSO (NPI# 1588017560) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588017560 |
| Entity Type | Individual |
| Full Name | KOMIVI WOMITSO |
| Credential | MD |
| Practice Address |
2708 Ferry St Lafayette IN 47904-3021 |
| Mailing Address |
Po Box 781076 Detroit MI 48278-1076 |
| Practice Telephone | 8045951418 |
| Mailing Telephone | 3175284800 |
| Mailing Fax Number | 3178651479 |
| Enumeration Date | 2016-07-14 |
| Last Update Date | 2020-09-30 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 01084238A | IN | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
2708 FERRY ST |
| City | LAFAYETTE |
| State | IN |
| Zip Code | 47904-3021 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285617803 | Mazen Alakhras | Internal Medicine | 2708 Ferry St, Lafayette, IN 47904 | 2005-11-29 |
| 1659982270 | Shana Moreno | Nurse Practitioner | 2708 Ferry St, Lafayette, IN 47904-3021 | 2020-08-17 |
| 1558980565 | Shaun Kelli Chalfant | Registered Nurse | 2708 Ferry St, Lafayette, IN 47904-3021 | 2020-04-09 |
| 1528616513 | Kerri Rene Dexter | Registered Nurse | 2708 Ferry St, Lafayette, IN 47904-3021 | 2019-09-03 |
| 1912365131 | Lindsay Michelle Vanlaere | Nurse Practitioner | 2708 Ferry St, Lafayette, IN 47904-3021 | 2016-02-02 |
| 1609057769 | Brooke Ellen Pletcher | Family Medicine | 2708 Ferry St, Lafayette, IN 47904-3021 | 2007-11-16 |
| 1578671236 | Juliana Rae Gaeta | Family Medicine | 2708 Ferry St, Lafayette, IN 47904-3021 | 2006-08-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568998615 | Angela Hands | Physical Therapy Assistant | 1260 North 17th Street, Lafayette, IN 47904 | 2017-05-11 |
| 1366894164 | Kathryn Barnett | Behavioral Analyst | 2785 Cason St # 2, Lafayette, IN 47904 | 2016-07-06 |
| 1881972917 | Rest Assured, LLC | Durable Medical Equipment & Medical Supplies | 180 Professional Ct., Lafayette, IN 47904 | 2011-07-22 |
| 1144514233 | Michelle Cristin Singleton | Dietitian, Registered | 508 N 26th St, Lafayette, IN 47904 | 2011-06-06 |
| 1912134438 | Jean D Trammel | Marriage & Family Therapist | 2000 Greenburg St, Bldg B, Suite A, Lafayette, IN 47904 | 2009-06-11 |
| 1902946056 | Terry Richard Baker | Optometrist | 2300 Sagamore Parkway S, Lafayette, IN 47904 | 2007-02-07 |
| 1891862165 | Becki A Bowditch Inc | Social Worker | 2201 Ferry Street, Lafayette, IN 47904 | 2006-11-29 |
| 1326121849 | James Lowell Thomas | Pediatrics | 2300 Ferry St, Lafayette, IN 47904 | 2006-10-21 |
| 1700976719 | Michael Leonard Bagnoli | Dentist | 2020 Union Street, Suite 200, Lafayette, IN 47904 | 2006-10-13 |
| 1255428801 | Lynn Arlen Pestle | Dentist | 2550 Elmwood Avenue, Lafayette, IN 47904 | 2006-10-06 |
| Find all providers in zip 47904 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568060135 | Audubon Family Medicine LLC | Family Medicine | 2301 Moss St, Lafayette, LA 70501-2125 | 2020-10-15 |
| 1871116244 | Partners In Primary Care La PC | Family Medicine | 537 Bertrand Dr Ste F0a, Lafayette, LA 70506-5556 | 2020-05-20 |
| 1013471259 | Courtney Cobb | Family Medicine | 500 Juliette Pl, Lafayette, LA 70506-4571 | 2019-01-22 |
| 1538672993 | Pamela Rene Roeder | Family Medicine | 8196 N 1000 E, Lafayette, IN 47905-9742 | 2017-11-08 |
| 1790297935 | Diamond Medical Group | Family Medicine | 830 Park East Blvd, Lafayette, IN 47905-0778 | 2017-10-27 |
| 1780114074 | Mimi Nguyen | Family Medicine | 4212 W Congress St Ste 1600, Lafayette, LA 70506-6767 | 2017-06-19 |
| 1679922249 | Lafayette Health Ventures, Inc | Family Medicine | 917 W Gloria Switch Road, Lafayette, LA 70507-2309 | 2016-06-06 |
| 1003278854 | Rebecca Lynn Currier Curran | Family Medicine | 2932 Ambassador Caffery Parkway, Lafayette, LA 70506 | 2016-03-22 |
| 1871989244 | Justin Matthew Pratt | Family Medicine | 1630 Rue Du Belier Apt 1307, Lafayette, LA 70506 | 2015-04-12 |
| 1558761973 | A. Elaine Ashby, M.d., Inc. | Family Medicine | 3732 Mt Diablo Blvd Ste 385, Lafayette, CA 94549-3625 | 2014-09-04 |
| Find all providers in LAFAYETTE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.