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General NPI Number Information
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NPI Number | 1235359407
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Entity Type | Individual
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Provider Name | MAXINE J MINTO M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/27/2007
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Last Update Date | 12/19/2023
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Provider Practice Location Address
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Address Line | 3365 S 103 RD ST, SUITE 210
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City | GREENFIELD
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State | WI
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Zip | 53227-4108
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Country | US
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Telephone | 414-266-3339
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Fax | 414-266-3735
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Provider Business Mailing Address
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Address Line | 10524 MOSS PARK RD STE 204-719
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City | ORLANDO
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State | FL
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Zip | 32832-5898
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Country | US
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Telephone | 814-217-6656
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 69898
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 69898
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License Number State | FL
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