MEDICARE: JOHN W MINA DPM PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	PO1386	FL

General Provider Information

NPI Number	:	1003028747
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN W MINA DPM PA

Provider Business Mailing Address
First Line	:	8851 BOARDROOM CIR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-4888
Country	:	US
Telephone Number	:	239-481-7000
Fax Number	:	239-481-8150

Provider Business Practice Location Address
First Line	:	88 PINE ISLAND RD STE 2
Second Line	:
City	:	N FORT MYERS
State	:	FL
Zip	:	33903-3745
Country	:	US
Telephone Number	:	239-481-7000
Fax Number	:	239-481-8150

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN W MINA
Credential	:	DPM
Telephone Number	:	239-481-7000

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	06/10/2008

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