Provider Demographics
NPI:1467414433
Name:MINOTTI, AMERICO MICHAEL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:AMERICO
Middle Name:MICHAEL
Last Name:MINOTTI
Suffix:JR
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 1:250 JOHNSON RIDGE MEDICAL PARK
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-2443
Mailing Address - Country:US
Mailing Address - Phone:336-526-1977
Mailing Address - Fax:336-526-0061
Practice Address - Street 1:250 JOHNSON RIDGE MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2443
Practice Address - Country:US
Practice Address - Phone:336-526-1977
Practice Address - Fax:336-526-0061
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC96-00345207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890264PMedicaid
NC6307OtherPARTNERS
NC0264POtherBLUE CROSS BLUE SHIELD
NC2230140Medicare ID - Type Unspecified
NC6307OtherPARTNERS