1972536639 NPI number — ANDREW P MINIGUTTI MD

Table of content: ANDREW P MINIGUTTI MD (NPI 1972536639)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972536639 NPI number — ANDREW P MINIGUTTI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MINIGUTTI
Provider First Name:
ANDREW
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972536639
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4280 MAIN ST
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
FRISCO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75033-3080
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-464-2510
Provider Business Mailing Address Fax Number:
214-705-1379

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4280 MAIN ST
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75033-3075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-464-2510
Provider Business Practice Location Address Fax Number:
214-705-1379
Provider Enumeration Date:
07/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2083B0002X , with the licence number:  85855495 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: L3756 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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