MEDICARE: MR. DANIEL QUINN MINTER IV

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	207Q00000X	Family Medicine Physician	01094484A	IN

General Provider Information

NPI Number	:	1144807785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL QUINN MINTER IV

Provider Business Mailing Address
First Line	:	2930 W CLEVELAND ROAD EXT
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46628-6090
Country	:	US
Telephone Number	:	574-335-8450
Fax Number	:	574-335-0780

Provider Business Practice Location Address
First Line	:	2930 W CLEVELAND ROAD EXT
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46628-6090
Country	:	US
Telephone Number	:	574-335-8450
Fax Number	:	574-335-0780

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2021
Last Update Date	:	08/01/2024

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