Provider Demographics
NPI:1790894368
Name:MINDRUM, MICHAEL REID (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:REID
Last Name:MINDRUM
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:CVMC MEDICAL GROUP PRACTICES
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-371-5326
Mailing Address - Fax:802-371-5339
Practice Address - Street 1:225 S MAIN ST
Practice Address - Street 2:BARRE INTERNAL MEDICINE
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-4815
Practice Address - Country:US
Practice Address - Phone:802-479-3302
Practice Address - Fax:802-479-2517
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
VT042-0011197207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine