Provider Demographics
NPI:1659519429
Name:THAI, MINHTAM T (DPM)
Entity Type:Individual
Prefix:
First Name:MINHTAM
Middle Name:T
Last Name:THAI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:1395 NW 167TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5710
Mailing Address - Country:US
Mailing Address - Phone:305-628-6117
Mailing Address - Fax:
Practice Address - Street 1:4106 PORTSMOUTH BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701
Practice Address - Country:US
Practice Address - Phone:757-393-1136
Practice Address - Fax:757-698-2499
Is Sole Proprietor?:No
Enumeration Date:2009-01-31
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0103301001213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0103301001OtherCOMMONWEALTH OF VIRGINIA