Healthcare Provider Details

I. General information

NPI: 1053524017
Provider Name (Legal Business Name): DAVID ANTHONY MINTER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N PERRY ST
PONTIAC MI
48342-2217
US

IV. Provider business mailing address

711 E 3RD ST
ROYAL OAK MI
48067-2860
US

V. Phone/Fax

Practice location:
  • Phone: 248-338-5000
  • Fax:
Mailing address:
  • Phone: 517-410-1699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101016960
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101016960
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: