Healthcare Provider Details

I. General information

NPI: 1255597738
Provider Name (Legal Business Name): DARIN M MINKIN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 DOUGHERTY FERRY RD STE 430
SAINT LOUIS MO
63122-3356
US

IV. Provider business mailing address

2355 DOUGHERTY FERRY RD STE 430
SAINT LOUIS MO
63122-3356
US

V. Phone/Fax

Practice location:
  • Phone: 314-965-8410
  • Fax:
Mailing address:
  • Phone: 314-965-8410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number200170421
License Number StateMO

VIII. Authorized Official

Name: SHANNON MARTI
Title or Position: MANAGER
Credential:
Phone: 888-826-4546