MEDICARE: KATHLEEN ELIZABETH MINNICK 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	208600000X	Surgery Physician	ME 78137	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4586865	OTHER	FL	AETNA
2	P971167	OTHER	FL	OPTIMUM
3	1023956	OTHER	FL	CAREPLUS
4	1092080	OTHER	FL	WELLCARE
5	259940	OTHER	FL	AVMED
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	46572	OTHER	FL	BCBS
8	8877	OTHER	FL	DIMENSION
9	P1035432	OTHER	FL	FREEDOM

General Provider Information

NPI Number	:	1609861202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN ELIZABETH MINNICK MD

Provider Business Mailing Address
First Line	:	PO BOX 20800
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-4105
Country	:	US
Telephone Number	:	561-270-5505
Fax Number	:	561-437-0177

Provider Business Practice Location Address
First Line	:	11551 SOUTHERN BLVD STE 2
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-4254
Country	:	US
Telephone Number	:	561-594-1850
Fax Number	:	561-594-1855

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	11/11/2025

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