Individual
MICHAEL R, MINAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 COTTONWOOD CT, SUITE 150, EAGLE, ID 83616-6545
(208) 939-3314
(208) 939-3315
Mailing address
PO BOX 1909, EAGLE, ID 83616-9108
(208) 939-3314
(208) 939-3315
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M-8587
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806518400
—
ID
01
—
841636078
TAX I. D. NUMBER
ID
Enumeration date
08/30/2006
Last updated
01/12/2011
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