Individual
MINTESINOT FITAMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1230 E RUSHOLME ST STE 109, DAVENPORT, IA 52803-2400
(563) 421-3120
Mailing address
1230 E RUSHOLME ST STE 109, DAVENPORT, IA 52803-2400
(563) 421-3120
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD-43498
IA
207Q00000X
Family Medicine Physician
R-9658
IA
Other
Enumeration date
11/11/2013
Last updated
04/28/2021
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