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General NPI Number Information
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NPI Number | 1346215787
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Entity Type | Individual
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Provider Name | SANDRA K. MINCHOW-PROFFITT M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/21/2006
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Last Update Date | 05/23/2022
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Provider Practice Location Address
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Address Line | 103 N TAYLOR AVE, STE C
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City | KIRKWOOD
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State | MO
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Zip | 63122-4360
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Country | US
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Telephone | 314-380-4566
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Fax | 314-743-3700
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Provider Business Mailing Address
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Address Line | 103 N TAYLOR AVE, STE C
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City | KIRKWOOD
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State | MO
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Zip | 63122-4360
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Country | US
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Telephone | 314-380-4566
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Fax | 314-743-3700
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2004008255
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License Number State | MO
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