Provider Demographics
NPI:1689791147
Name:MINUTH, ANDRE NICOLAI (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:NICOLAI
Last Name:MINUTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANDRE
Other - Middle Name:NICOLAI
Other - Last Name:MINUTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8590 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-1746
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8590 N 3RD ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-1746
Practice Address - Country:US
Practice Address - Phone:559-439-2045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24612207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology