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General NPI Number Information
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NPI Number | 1720742968
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Entity Type | Individual
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Provider Name | LAURA MICHELE MINIK PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/25/2021
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 75 SYLVANIA DR
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City | BEAVERCREEK
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State | OH
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Zip | 45440-3237
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Country | US
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Telephone | 937-320-5050
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Fax | 937-320-5060
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Provider Business Mailing Address
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Address Line | ONE GI CREDENTIALING DEPARTMENT PO BOX 381468
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City | GERMANTOWN
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State | TN
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Zip | 38183-4258
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.007120RX
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License Number State | OH
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