Healthcare Provider Details

I. General information

NPI: 1073879128
Provider Name (Legal Business Name): UNA CLARE MINITER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 JOHN DEERE RD STE 200
MOLINE IL
61265-6897
US

IV. Provider business mailing address

600 JOHN DEERE RD STE 200
MOLINE IL
61265-6897
US

V. Phone/Fax

Practice location:
  • Phone: 309-779-4200
  • Fax: 309-779-4305
Mailing address:
  • Phone: 309-779-4200
  • Fax: 309-779-4305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD176337
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number036160480
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: