MEDICARE: DR. MATTHEW CAMERON MINICK 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	DR0074361	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	46101	OTHER	FL	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811926959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW CAMERON MINICK M.D.

Provider Business Mailing Address
First Line	:	2121 S ONEIDA ST STE 200
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80224-2551
Country	:	US
Telephone Number	:	303-757-6418
Fax Number	:	303-757-2209

Provider Business Practice Location Address
First Line	:	2121 S ONEIDA ST STE 200
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80224-2551
Country	:	US
Telephone Number	:	303-757-6418
Fax Number	:	303-757-2209

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

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	10/22/2025

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