Healthcare Provider Details

I. General information

NPI: 1881681112
Provider Name (Legal Business Name): TODD J MINARS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 02/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 SHERIDAN ST SUITE C
HOLLYWOOD FL
33021-3559
US

IV. Provider business mailing address

4060 SHERIDAN ST SUITE C
HOLLYWOOD FL
33021-3559
US

V. Phone/Fax

Practice location:
  • Phone: 954-987-7512
  • Fax: 954-987-3977
Mailing address:
  • Phone: 954-987-7512
  • Fax: 954-987-3977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME84931
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: