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General NPI Number Information
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NPI Number | 1720131733
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Entity Type | Organization
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Legal Business Name | MICHAEL G. MINTER MDSC
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Dates
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Enumeration Date | 01/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9200 W LOOMIS RD STE 203
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City | FRANKLIN
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State | WI
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Zip | 53132-9658
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Country | US
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Telephone | 414-425-8518
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Fax | 414-425-8517
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Provider Business Mailing Address
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Address Line | 9200 W LOOMIS RD STE 203
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City | FRANKLIN
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State | WI
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Zip | 53132-9658
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Country | US
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Telephone | 414-425-8518
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Fax | 414-425-8517
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL G. MINTER
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Credential | MD
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Telephone | 414-425-8518
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 18238020
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License Number State | WI
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