Basic Information
| Provider Information | |||||||||
| NPI: | 1952339079 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MINK | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1529 E GAYLORD ST | ||||||||
| Address2: | |||||||||
| City: | MOUNT PLEASANT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488586609 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1221 SOUTH DR | ||||||||
| Address2: | |||||||||
| City: | MOUNT PLEASANT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488583258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897731166 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 06/16/2009 | ||||||||
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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 | 363A00000X | 003236 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 207P00000X | 5601003236 | MI | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.