Provider Demographics
NPI:1215000757
Name:MINIET, RALPH (MD)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:
Last Name:MINIET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 NW 57TH AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3275
Mailing Address - Country:US
Mailing Address - Phone:305-262-7742
Mailing Address - Fax:305-262-7736
Practice Address - Street 1:701 NW 57TH AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3275
Practice Address - Country:US
Practice Address - Phone:305-262-7742
Practice Address - Fax:305-262-7736
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME52935207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE30585Medicare UPIN
FL08758Medicare ID - Type UnspecifiedPROVIDER