Provider Demographics
NPI:1942239819
Name:MINAUDO, MARK J (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:MINAUDO
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:3495 S CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48519-1455
Mailing Address - Country:US
Mailing Address - Phone:810-424-2011
Mailing Address - Fax:810-249-4037
Practice Address - Street 1:600 HEALTH PARK BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2558
Practice Address - Country:US
Practice Address - Phone:810-424-2011
Practice Address - Fax:810-249-4037
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2015-08-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101017639207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology