MEDICARE: ISAAC M MINEHART M.D.

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
1	174400000X	Specialist	A44356	CA
2	208VP0014X	Interventional Pain Medicine Physician	A44356	CA
3	207LP2900X	Pain Medicine (Anesthesiology) Physician	A44356	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639167091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISAAC M MINEHART M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1464
Second Line	:
City	:	ARCADIA
State	:	CA
Zip	:	91077-1464
Country	:	US
Telephone Number	:	626-445-2371
Fax Number	:	626-445-2618

Provider Business Practice Location Address
First Line	:	638 W DUARTE RD
Second Line	:	SUITE 18
City	:	ARCADIA
State	:	CA
Zip	:	91007-7616
Country	:	US
Telephone Number	:	626-445-2371
Fax Number	:	626-445-2618

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	11/02/2020

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Directions to “ ISAAC M MINEHART M.D.” Practice Location

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