Provider Demographics
NPI:1154311009
Name:PARAB, MINOTI VILAS (MD)
Entity Type:Individual
Prefix:
First Name:MINOTI
Middle Name:VILAS
Last Name:PARAB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3816 HIGHWAY 17 S
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-5069
Mailing Address - Country:US
Mailing Address - Phone:843-272-1411
Mailing Address - Fax:843-272-2130
Practice Address - Street 1:300 71 STREET
Practice Address - Street 2:SUITE 620
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-3089
Practice Address - Country:US
Practice Address - Phone:305-866-9951
Practice Address - Fax:877-284-8933
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28324207Q00000X
SC28382208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC283829Medicaid
SCAA11119084Medicare PIN
SC283829Medicaid
NC2075826Medicare PIN
SCAA11119517Medicare PIN