Individual
DIANE M MINICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
86 CONSERVATORY DR, SUITE B, BARBERTON, OH 44203-4289
(330) 753-8802
(330) 753-8841
Mailing address
86 CONSERVATORY DR, SUITE B, BARBERTON, OH 44203-4289
(330) 753-8802
(330) 753-8841
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35052203M
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000256797
ANTHEM
OH
05
—
2003549
—
OH
01
—
481283219027
CARESOURCE
OH
01
—
9330191
MEDICARE BILLING NUMBER
—
Enumeration date
07/06/2006
Last updated
11/29/2007
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