Provider Demographics
NPI:1518100924
Name:MINDER, CAMILLE MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:CAMILLE
Middle Name:MICHAEL
Last Name:MINDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5169 S COTTONWOOD ST
Mailing Address - Street 2:STE. 520 BLDG. 2 OUTPATIENT CENTER
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6767
Mailing Address - Country:US
Mailing Address - Phone:801-507-3500
Mailing Address - Fax:801-507-3505
Practice Address - Street 1:5169 S COTTONWOOD ST
Practice Address - Street 2:STE. 520 BLDG. 2 OUTPATIENT CENTER
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-6767
Practice Address - Country:US
Practice Address - Phone:801-507-3500
Practice Address - Fax:801-507-3505
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2017-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0073872207R00000X
UT9768009-1205207RC0000X
NC2013-00328207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD241569Y3WMedicare PIN
MDP01157323Medicare PIN