MEDICARE: DR. STEPHEN MINNIS M.D.

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	208000000X	Pediatrics Physician	35054785M	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000177369	OTHER	OH	UNISON PIN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000019439	OTHER	OH	ANTHEM PIN
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	1204559	OTHER	OH	UHC PIN
6	311413469027	OTHER	OH	CARESOURCE PIN

General Provider Information

NPI Number	:	1366428229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN MINNIS M.D.

Provider Business Mailing Address
First Line	:	860 BETHESDA DR
Second Line	:
City	:	ZANESVILLE
State	:	OH
Zip	:	43701-1800
Country	:	US
Telephone Number	:	740-454-4651
Fax Number	:	740-454-4653

Provider Business Practice Location Address
First Line	:	751 FOREST AVE
Second Line	:	SUITE 401
City	:	ZANESVILLE
State	:	OH
Zip	:	43701-2868
Country	:	US
Telephone Number	:	740-454-8502
Fax Number	:	740-454-8641

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

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	04/01/2008

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Directions to “ DR. STEPHEN MINNIS M.D.” Practice Location

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