Provider Demographics
NPI:1639167091
Name:MINEHART, ISAAC M (MD)
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:M
Last Name:MINEHART
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:PO BOX 1464
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91077-1464
Mailing Address - Country:US
Mailing Address - Phone:626-445-2371
Mailing Address - Fax:626-445-2618
Practice Address - Street 1:638 W DUARTE RD
Practice Address - Street 2:SUITE 18
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7616
Practice Address - Country:US
Practice Address - Phone:626-445-2371
Practice Address - Fax:626-445-2618
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44356174400000X, 208VP0014X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A443561Medicaid
CAE50361Medicare UPIN
CA00A443561Medicaid