Provider Demographics
NPI:1275834376
Name:CORLETT & MINTEK PLLC
Entity Type:Organization
Organization Name:CORLETT & MINTEK PLLC
Other - Org Name:DOWNTOWN ALLEGAN FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER/OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:MINTEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-686-0600
Mailing Address - Street 1:350 KALAMAZOO ST
Mailing Address - Street 2:
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-1664
Mailing Address - Country:US
Mailing Address - Phone:269-686-0600
Mailing Address - Fax:
Practice Address - Street 1:300 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-1316
Practice Address - Country:US
Practice Address - Phone:269-686-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301053933207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty