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NPI Code Detail

MEDICARE: LAURA MICHELE MINIK PA-C

MEDICARE: LAURA MICHELE MINIK PA-C
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
1363A00000XPhysician Assistant50.007120RXOH

General Provider Information

NPI Number : 1720742968
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA MICHELE MINIK PA-C
Provider Business Mailing Address
First Line : ONE GI CREDENTIALING DEPARTMENT
Second Line : PO BOX 381468
City : GERMANTOWN
State : TN
Zip : 38183-4258
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 75 SYLVANIA DR
Second Line :
City : BEAVERCREEK
State : OH
Zip : 45440-3237
Country : US
Telephone Number : 937-320-5050
Fax Number : 937-320-5060
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2021
Last Update Date : 02/09/2026

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Directions to “ LAURA MICHELE MINIK PA-C” Practice Location

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