=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114360088
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | I MICHAEL MINEHART M D INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2013
-----------------------------------------------------
Last Update Date | 10/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 638 W DUARTE RD SUITE 18
-----------------------------------------------------
City | ARCADIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91007-7616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-445-2371
-----------------------------------------------------
Fax | 626-445-2618
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1464
-----------------------------------------------------
City | ARCADIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91077-1464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-445-2371
-----------------------------------------------------
Fax | 626-445-2618
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR/OWNER
-----------------------------------------------------
Name | DR. ISAAC M MINEHART
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 626-445-2371
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number | A44356
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2081P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | A44356
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 208VP0000X
-----------------------------------------------------
Taxonomy Name | Pain Medicine Physician
-----------------------------------------------------
License Number | A44356
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------