Provider Demographics
NPI:1720131733
Name:MICHAEL G. MINTER MDSC
Entity Type:Organization
Organization Name:MICHAEL G. MINTER MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:MINTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-425-8518
Mailing Address - Street 1:9200 W LOOMIS RD STE 203
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-9658
Mailing Address - Country:US
Mailing Address - Phone:414-425-8518
Mailing Address - Fax:414-425-8517
Practice Address - Street 1:9200 W LOOMIS RD STE 203
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-9658
Practice Address - Country:US
Practice Address - Phone:414-425-8518
Practice Address - Fax:414-425-8517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18238020261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30237100Medicaid
WIB55146Medicare UPIN