Provider Demographics
NPI:1225149735
Name:MINTZER, MICHAEL C (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:MINTZER
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 1:6000 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8203
Mailing Address - Country:US
Mailing Address - Phone:515-241-2200
Mailing Address - Fax:515-241-2201
Practice Address - Street 1:6000 UNIVERSITY AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8203
Practice Address - Country:US
Practice Address - Phone:515-241-2200
Practice Address - Fax:515-241-2201
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA32297207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1225149735Medicaid
IAP00821974OtherRR MEDICARE
IA0170936Medicaid
IA0170936Medicaid
IA1225149735Medicaid
IAP00821974OtherRR MEDICARE