Provider Demographics
NPI:1306811765
Name:MINERT, DANIEL QUENTIN (C O)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:QUENTIN
Last Name:MINERT
Suffix:
Gender:M
Credentials:C O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48139-0215
Mailing Address - Country:US
Mailing Address - Phone:810-231-6905
Mailing Address - Fax:810-231-6906
Practice Address - Street 1:10020 PROFESSIONAL DRIVE
Practice Address - Street 2:SUITE 140
Practice Address - City:HAMBURG
Practice Address - State:MI
Practice Address - Zip Code:48139-0215
Practice Address - Country:US
Practice Address - Phone:810-231-6905
Practice Address - Fax:810-231-6906
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI510D703120OtherBLUE CROSS BLUE SHIELD MI
MI4489299Medicaid
MI4489299Medicaid