Healthcare Provider Details

I. General information

NPI: 1306811765
Provider Name (Legal Business Name): DANIEL QUENTIN MINERT C. O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 04/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10020 PROFESSIONAL DRIVE SUITE 140
HAMBURG MI
48139-0215
US

IV. Provider business mailing address

PO BOX 215
HAMBURG MI
48139-0215
US

V. Phone/Fax

Practice location:
  • Phone: 810-231-6905
  • Fax: 810-231-6906
Mailing address:
  • Phone: 810-231-6905
  • Fax: 810-231-6906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: