Provider Demographics
NPI:1265881809
Name:MINKOWSKI, JONATHAN SHREVE (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:SHREVE
Last Name:MINKOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60160
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0160
Mailing Address - Country:US
Mailing Address - Phone:704-365-0555
Mailing Address - Fax:704-367-8122
Practice Address - Street 1:135 S SHARON AMITY RD STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-3870
Practice Address - Country:US
Practice Address - Phone:704-365-0555
Practice Address - Fax:704-367-8120
Is Sole Proprietor?:No
Enumeration Date:2016-06-05
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA85048207W00000X
IL125069078207W00000X
NC2021-00483207WX0120X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist