Provider Demographics
NPI:1235359407
Name:MINTO, MAXINE J (MD)
Entity Type:Individual
Prefix:DR
First Name:MAXINE
Middle Name:J
Last Name:MINTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10524 MOSS PARK RD STE 204-719
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-5898
Mailing Address - Country:US
Mailing Address - Phone:814-217-6656
Mailing Address - Fax:
Practice Address - Street 1:3365 S 103 RD ST, SUITE 210
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53227-4108
Practice Address - Country:US
Practice Address - Phone:414-266-3339
Practice Address - Fax:414-266-3735
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL698982084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL41442Medicare ID - Type Unspecified