Provider Demographics
NPI:1073513628
Name:MINTURN, JOHN THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:THOMAS
Last Name:MINTURN
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 1:10300 N ILLINOIS ST
Mailing Address - Street 2:SUITE #1030
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46290-1166
Mailing Address - Country:US
Mailing Address - Phone:317-817-1586
Mailing Address - Fax:317-817-1399
Practice Address - Street 1:10300 N ILLINOIS ST
Practice Address - Street 2:SUITE #1030
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46290-1166
Practice Address - Country:US
Practice Address - Phone:317-817-1586
Practice Address - Fax:317-817-1399
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01035051A207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100226850BMedicaid
INB29461Medicare UPIN
IN100226850BMedicaid