Healthcare Provider Details

I. General information

NPI: 1609861202
Provider Name (Legal Business Name): KATHLEEN ELIZABETH MINNICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11551 SOUTHERN BLVD STE 2
ROYAL PALM BEACH FL
33411-4254
US

IV. Provider business mailing address

PO BOX 20800
BELFAST ME
04915-4105
US

V. Phone/Fax

Practice location:
  • Phone: 561-594-1850
  • Fax: 561-594-1855
Mailing address:
  • Phone: 561-270-5505
  • Fax: 561-437-0177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME 78137
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: