Basic Information
| Provider Information | |||||||||
| NPI: | 1326663998 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MINAXI, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 639030 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452639030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592914800 | ||||||||
| FaxNumber: | 8592914801 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 AUSTIN GRAYBILL RD | ||||||||
| Address2: | |||||||||
| City: | NORTH AUGUSTA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 298609251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8032784272 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2020 | ||||||||
| LastUpdateDate: | 06/10/2020 | ||||||||
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| AuthorizedOfficialLastName: | THAKORE | ||||||||
| AuthorizedOfficialFirstName: | HETAL | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7062677681 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 06/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.