Healthcare Provider Details

I. General information

NPI: 1649175852
Provider Name (Legal Business Name): STEVEN MINTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8557 S ESSEX AVE
CHICAGO IL
60617-2334
US

IV. Provider business mailing address

8557 S ESSEX AVE
CHICAGO IL
60617-2334
US

V. Phone/Fax

Practice location:
  • Phone: 773-731-6658
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: