Provider Demographics
NPI:1033140959
Name:MINKOW, FREDERICK VICTOR (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:VICTOR
Last Name:MINKOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43700 WOODWARD AVENUE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0561
Mailing Address - Country:US
Mailing Address - Phone:248-332-8391
Mailing Address - Fax:248-332-8525
Practice Address - Street 1:43700 WOODWARD AVENUE
Practice Address - Street 2:SUITE 205
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0561
Practice Address - Country:US
Practice Address - Phone:248-332-8391
Practice Address - Fax:248-332-8525
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIFM026651207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4033162OtherAETNA
MI2006364692OtherBCBS OF MICHIGAN
MIN98590002Medicare PIN
MI4033162OtherAETNA
B46868Medicare UPIN