Provider Demographics
NPI:1679073001
Name:MINIACI, ANTHONY (DO)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:MINIACI
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 1:6150 OAK TREE BLVD STE 100A
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-6917
Mailing Address - Country:US
Mailing Address - Phone:440-743-8145
Mailing Address - Fax:216-201-6382
Practice Address - Street 1:6150 OAK TREE BLVD STE 100A
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-6917
Practice Address - Country:US
Practice Address - Phone:440-743-8145
Practice Address - Fax:216-201-6382
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2021-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.014466207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program