Charles Mininger

NPI 1508146309 - Physician Assistant - 363A00000X

NPI Details
NPI 1508146309
Gender Male
Enumeration Date 08/24/2011
Last Updated 08/25/2011
Entity Type Individual
Active Over 5 years ago
Practice Location
2650 RIDGE AVE
EVANSTON IL, 60201-1718, US
Phone (847) 570-2000
Fax
Business Location
444 W FULLERTON PKWY APT 1801
CHICAGO IL, 60614-2852, US
Phone
Fax
Toxanomy
Taxonomy Code 363A00000X
License State Illinois
License Number 085004089
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According to our database, Charles Mininger NPI is 1508146309, taxonomy code is 363A00000X and license number is 085004089, license state is located at Illinois. Charles Mininger physically located at 2650 Ridge Ave, Evanston IL, 60201-1718. NPI Number Charles Mininger has the Individual type.

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1508146309 NPI number is provided on an as is basis without warranty of any kind. 1508146309 is maintained by the National Plan & Provider Enumeration System. The contents of Charles Mininger are for informational purposes only.