MEDICARE: DR. MINMIN LUO MD, PHD

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	207V00000X	Obstetrics & Gynecology Physician	325184	NY

General Provider Information

NPI Number	:	1467911644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MINMIN LUO MD, PHD

Provider Business Mailing Address
First Line	:	4514 16TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-1101
Country	:	US
Telephone Number	:	718-407-7300
Fax Number	:	347-735-5623

Provider Business Practice Location Address
First Line	:	4514 16TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-1101
Country	:	US
Telephone Number	:	718-407-7304
Fax Number	:	347-442-5830

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

Provider Enumeration Date	:	03/18/2019
Last Update Date	:	08/15/2023

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