Provider Demographics
NPI:1558357491
Name:MINARS, NORMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:
Last Name:MINARS
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 1:4060 SHERIDAN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3559
Mailing Address - Country:US
Mailing Address - Phone:954-987-7512
Mailing Address - Fax:954-987-3977
Practice Address - Street 1:4060 SHERIDAN ST
Practice Address - Street 2:SUITE C
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3559
Practice Address - Country:US
Practice Address - Phone:954-987-7512
Practice Address - Fax:954-987-3977
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME24872174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL78216OtherBC & BS OF FLORIDA
FL267519600Medicaid
FLD58403Medicare UPIN
FL267519600Medicaid