Healthcare Provider Details

I. General information

NPI: 1376121459
Provider Name (Legal Business Name): KRISTINA LYNN MINNITI DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3226 KENT RD
STOW OH
44224-4429
US

IV. Provider business mailing address

3226 KENT RD
STOW OH
44224-4429
US

V. Phone/Fax

Practice location:
  • Phone: 330-929-3331
  • Fax: 330-929-5408
Mailing address:
  • Phone: 330-929-3331
  • Fax: 330-929-5408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36.004133
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: