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NPI Code Detail

MEDICARE: DR. ANN L MINCIOTTI MD

MEDICARE: DR. ANN L MINCIOTTI MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianIL

General Provider Information

NPI Number : 1558343426
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANN L MINCIOTTI MD
Provider Business Mailing Address
First Line : 5057 SHORELINE RD
Second Line :
City : LAKE BARRINGTON
State : IL
Zip : 60010-1700
Country : US
Telephone Number : 847-381-5005
Fax Number : 847-381-5036
Provider Business Practice Location Address
First Line : 5057 SHORELINE RD
Second Line :
City : LAKE BARRINGTON
State : IL
Zip : 60010-1700
Country : US
Telephone Number : 847-381-5005
Fax Number : 847-381-5036
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2005
Last Update Date : 07/08/2007

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Directions to “ DR. ANN L MINCIOTTI MD” Practice Location

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