MEDICARE: DR. MICHAEL ANTHONY MINADEO 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
1	174400000X	Specialist	G7852	TX

Other Identifiers

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

General Provider Information

NPI Number	:	1356323489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL ANTHONY MINADEO MD

Provider Business Mailing Address
First Line	:	3900 E MEXICO AVE STE 102
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-3941
Country	:	US
Telephone Number	:	720-524-1001
Fax Number	:	720-524-1121

Provider Business Practice Location Address
First Line	:	2007 N JEFFERSON AVE
Second Line	:
City	:	MOUNT PLEASANT
State	:	TX
Zip	:	75455-2336
Country	:	US
Telephone Number	:	817-784-0222
Fax Number	:	903-572-0213

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

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	04/21/2020

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