Provider Demographics
NPI:1780663500
Name:MINITER, MICHAEL FRANCIS (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:FRANCIS
Last Name:MINITER
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 1:2202 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-3614
Mailing Address - Country:US
Mailing Address - Phone:309-793-3400
Mailing Address - Fax:309-793-7323
Practice Address - Street 1:2202 18TH AVE
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-3614
Practice Address - Country:US
Practice Address - Phone:309-793-3400
Practice Address - Fax:309-793-7323
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036081977207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK06474OtherMEDICARE IND. PROVIDER #
IL036081977Medicaid
ILK06474OtherMEDICARE IND. PROVIDER #