Provider Demographics
NPI:1770031072
Name:MINODIN, MIKE (MD)
Entity Type:Individual
Prefix:
First Name:MIKE
Middle Name:
Last Name:MINODIN
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 44177
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NOVA SCOTIA
Mailing Address - Zip Code:B4A 3Z8
Mailing Address - Country:CA
Mailing Address - Phone:902-877-4362
Mailing Address - Fax:
Practice Address - Street 1:240 BAKER DRIVE
Practice Address - Street 2:SUITE 210
Practice Address - City:DARTMOUTH
Practice Address - State:NOVA SCOTIA
Practice Address - Zip Code:B2W 6L4
Practice Address - Country:CA
Practice Address - Phone:902-462-2038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0038642207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine