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General NPI Number Information
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NPI Number | 1346336427
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Entity Type | Individual
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Provider Name | MICHAEL G MINTER MD
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Gender | Male
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 9000 W WISCONSIN AVE
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City | MILWAUKEE
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State | WI
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Zip | 53226-4810
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Country | US
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Telephone | 414-266-2280
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Fax |
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Provider Business Mailing Address
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Address Line | 9177 W ELM CT UNIT A
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City | FRANKLIN
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State | WI
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Zip | 53132-7835
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Country | US
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Telephone | 414-702-9489
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 18283-20
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License Number State | WI
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