Provider Demographics
NPI:1457464992
Name:MINNICK, STEVEN E (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:E
Last Name:MINNICK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:22151 MOROSS RD
Mailing Address - Street 2:ST JOHN PROFESSIONAL BLDG 1 SUITE G33
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48236
Mailing Address - Country:US
Mailing Address - Phone:313-343-4050
Mailing Address - Fax:313-885-2110
Practice Address - Street 1:22151 MOROSS RD
Practice Address - Street 2:SUITE G33
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236
Practice Address - Country:US
Practice Address - Phone:313-343-4050
Practice Address - Fax:313-885-2110
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301044648207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E37469Medicare UPIN