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General NPI Number Information
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NPI Number | 1255481727
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Entity Type | Organization
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Legal Business Name | MICHELLE B. MINTZER, M.D., P.A.
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 08/23/2013
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Provider Practice Location Address
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Address Line | 600 CAISSON HILL RD
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City | FT RILEY
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State | KS
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Zip | 66442-7037
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Country | US
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Telephone | 913-111-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 1228 WESTLOOP PL PMB 214
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City | MANHATTAN
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State | KS
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Zip | 66502-2840
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Country | US
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Telephone | 913-111-1111
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHELLE B. MINTZER
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Credential | M.D.
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Telephone | 913-111-1111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 0423698
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0423698
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License Number State | KS
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