Healthcare Provider Details

I. General information

NPI: 1073513628
Provider Name (Legal Business Name): JOHN THOMAS MINTURN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11220 ILLINOIS ST STE 130
CARMEL IN
46032-8887
US

IV. Provider business mailing address

11220 ILLINOIS ST STE 130
CARMEL IN
46032-8887
US

V. Phone/Fax

Practice location:
  • Phone: 317-817-1586
  • Fax: 317-817-1399
Mailing address:
  • Phone: 317-817-1586
  • Fax: 317-817-1399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number01035051A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number01035051A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: