Provider Demographics
NPI:1164494746
Name:MINKUS, KIRK D (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:D
Last Name:MINKUS
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 1:5416 E BASELINE RD STE 129
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4703
Mailing Address - Country:US
Mailing Address - Phone:480-945-4343
Mailing Address - Fax:480-945-4350
Practice Address - Street 1:7529 E BROADWAY RD STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85208-2007
Practice Address - Country:US
Practice Address - Phone:480-945-4343
Practice Address - Fax:480-945-4350
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ330812085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1Z7086OtherHEALTH NET OF AZ
AZAZ0221810OtherBCBSAZ
AZ872227Medicaid
AZ1Z7086OtherHEALTH NET OF AZ
AZAZ0221810OtherBCBSAZ
AZ872227Medicaid
AZZ82272Medicare PIN
AZP00142370Medicare PIN
I11423Medicare UPIN
AZZ121408Medicare PIN
AZZ121143Medicare PIN