Provider Demographics
NPI:1659300747
Name:MINARDI, FRANK (DO)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:MINARDI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7447 W TALCOTT AVE
Mailing Address - Street 2:SUITE 515
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3745
Mailing Address - Country:US
Mailing Address - Phone:773-792-2100
Mailing Address - Fax:773-792-8578
Practice Address - Street 1:7447 W TALCOTT AVE
Practice Address - Street 2:SUITE 515
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3745
Practice Address - Country:US
Practice Address - Phone:773-792-2100
Practice Address - Fax:773-792-8578
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036062366207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31601286OtherBLUE SHIELD BLUE CROSS
IL036062366Medicaid
IL0328930001Medicare NSC
IL036062366Medicaid
IL31601286OtherBLUE SHIELD BLUE CROSS