Provider Demographics
NPI:1255597738
Name:DARIN M MINKIN INC
Entity type:Organization
Organization Name:DARIN M MINKIN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-826-4546
Mailing Address - Street 1:2355 DOUGHERTY FERRY RD
Mailing Address - Street 2:STE 430
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-3356
Mailing Address - Country:US
Mailing Address - Phone:314-965-8410
Mailing Address - Fax:
Practice Address - Street 1:2355 DOUGHERTY FERRY RD
Practice Address - Street 2:STE 430
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-3356
Practice Address - Country:US
Practice Address - Phone:314-965-8410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO200170421208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209057603Medicaid
MOI04862Medicare UPIN