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NPI Code Detail

MEDICARE: DR. KENNETH MINKOFF MD

MEDICARE: DR. KENNETH MINKOFF MD
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
12084P0802XAddiction Psychiatry Physician39497MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033103247
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENNETH MINKOFF MD
Provider Business Mailing Address
First Line : 100 POWDERMILL RD # 319
Second Line :
City : ACTON
State : MA
Zip : 01720-5932
Country : US
Telephone Number : 978-502-1729
Fax Number : 415-455-8016
Provider Business Practice Location Address
First Line : 100 POWDERMILL RD # 319
Second Line :
City : ACTON
State : MA
Zip : 01720-5932
Country : US
Telephone Number : 978-502-1729
Fax Number : 415-455-8016
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2005
Last Update Date : 11/29/2010

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