Individual
MINTO K PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2024 S 6TH ST, BRAINERD, MN 56401-4529
(218) 828-7100
(218) 828-7194
Mailing address
523 N 3RD ST, BRAINERD, MN 56401-3054
(218) 829-2861
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
46609
MN
208000000X
Pediatrics Physician
46609
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1041076
PREFERRED ONE
—
01
—
1202864
MEDICA HEALTH PLANS
—
01
—
131482
U CARE
—
01
—
183492400
MEDICAL ASSISTANCE
—
01
—
2121655
ARAZ GROUP
—
01
—
2197249
FIRST HEALTH PLAN
—
01
—
315M2PO
BLUE CROSS BLUE SHIELD
—
01
—
HP42090
HEALTH PARTNERS
—
Enumeration date
10/31/2005
Last updated
01/08/2016
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