MEDICARE: MOLLY A MINARD 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
1	363A00000X	Physician Assistant
2	207X00000X	Orthopaedic Surgery Physician	5601004682	MI

General Provider Information

NPI Number	:	1801887377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY A MINARD PA-C

Provider Business Mailing Address
First Line	:	110 BEECH ST STE B
Second Line	:
City	:	TAWAS CITY
State	:	MI
Zip	:	48763-8314
Country	:	US
Telephone Number	:	989-362-9859
Fax Number	:	989-362-9862

Provider Business Practice Location Address
First Line	:	110 BEECH ST
Second Line	:	STE B
City	:	TAWAS CITY
State	:	MI
Zip	:	48763-8314
Country	:	US
Telephone Number	:	989-362-1015
Fax Number	:	989-362-9862

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	04/06/2021

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Directions to “ MOLLY A MINARD PA-C” Practice Location

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