Healthcare Provider Details

I. General information

NPI: 1306292438
Provider Name (Legal Business Name): MINDY RAMINICK D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2016
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5280 METROPOLITAN PKWY
STERLING HEIGHTS MI
48310-4005
US

IV. Provider business mailing address

1512 MOHAWK AVE
ROYAL OAK MI
48067-3334
US

V. Phone/Fax

Practice location:
  • Phone: 248-290-3111
  • Fax: 248-290-3100
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5151010997
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number5101026106
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: