Provider Demographics
NPI:1699086504
Name:KOMAR, ALIX F (MD)
Entity type:Individual
Prefix:DR
First Name:ALIX
Middle Name:F
Last Name:KOMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ALIX
Other - Middle Name:F
Other - Last Name:LEADER-CRAMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 735044
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5044
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8905 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2468
Practice Address - Country:US
Practice Address - Phone:414-328-6000
Practice Address - Fax:414-328-8536
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.135542207V00000X, 207VF0040X
WI73700207V00000X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100102895Medicaid