Basic Information
| Provider Information | |||||||||
| NPI: | 1851380752 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COMNICK | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | BRIAN OLMSCHEID | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5200 FAIRVIEW BLVD | ||||||||
| Address2: | |||||||||
| City: | WYOMING | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550928013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6519827000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5200 FAIRVIEW BLVD | ||||||||
| Address2: | |||||||||
| City: | WYOMING | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550928013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6519827000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2005 | ||||||||
| LastUpdateDate: | 06/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 44941 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0406676 | 01 | MEDICA HEALTH PLANS | OTHER | 143209 | 01 | UCARE | OTHER | 2121656 | 01 | ARAZ GROUP AMERICAS PPO | OTHER | 81604 | 01 | CHAMPUS | OTHER | HP42375 | 01 | HEALTH PARTNERS | OTHER | 1041077 | 01 | PREFERRED ONE | OTHER | 882927600 | 05 | MN | MEDICAID | 842S4CO | 01 | BLUE CROSS BLUE SHIELD | OTHER | 81604 | 01 | FIRST HEALTH PLAN | OTHER | 882927600 | 01 | MEDICAL ASSISTANCE | OTHER | 92204 | 01 | ONE HEALTH PLAN GREAT WES | OTHER | EFF52704 | 01 | MMSI | OTHER |