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Individual

BOHDAN M MINCZAK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
245 N 15TH STREET, NCB ROOM 2108, PHILADELPHIA, PA 19102
(215) 762-2361
(215) 762-1307
Mailing address
1601 CHERRY ST, SUITE 11511, PHILADELPHIA, PA 19102-1320
(215) 255-7822
(215) 255-7825

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD064462L
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0017079530005
PA
05
8523801
NJ
Enumeration date
08/24/2005
Last updated
05/13/2016
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