Basic Information
| Provider Information | |||||||||
| NPI: | 1629053954 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MINKIN | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30840 NORHTWESTERN HWY | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | FARMINGTON HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483342555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2489321250 | ||||||||
| FaxNumber: | 2489328977 | ||||||||
| Practice Location | |||||||||
| Address1: | 30840 NORTHWESTERN HWY | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | FARMINGTON HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483342555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2489321250 | ||||||||
| FaxNumber: | 2489328977 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2005 | ||||||||
| LastUpdateDate: | 02/17/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301039817 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1629053954 | 05 | MI | MEDICAID | 700F319250 | 01 | MI | BLUE SHIELD | OTHER | 06301492 | 01 | MI | BCBS INDIVIDUAL | OTHER | 110241690 | 01 | MI | RR MEDICARE | OTHER | 15499 | 01 | MI | GREAT LAKES HEALTH PLAN | OTHER | 128906 | 01 | MI | CARE-PREFERRED CHOICES | OTHER |