Provider Demographics
NPI:1174194955
Name:MINAKER, SAMUEL ANTHONY (MD)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:ANTHONY
Last Name:MINAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:11516 183RD PL STE SW
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-9471
Mailing Address - Country:US
Mailing Address - Phone:708-877-1300
Mailing Address - Fax:708-596-8719
Practice Address - Street 1:71 W 156TH ST
Practice Address - Street 2:STE 400
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-4265
Practice Address - Country:US
Practice Address - Phone:708-596-8710
Practice Address - Fax:708-915-2798
Is Sole Proprietor?:No
Enumeration Date:2021-07-02
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036155679207W00000X
IL036.155679207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036155679Medicaid