Provider Demographics
NPI:1316918014
Name:NEIMARK, MINDA (MD)
Entity type:Individual
Prefix:
First Name:MINDA
Middle Name:
Last Name:NEIMARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6405 N FEDERAL HWY
Mailing Address - Street 2:SUITE 402
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1412
Mailing Address - Country:US
Mailing Address - Phone:954-771-8888
Mailing Address - Fax:954-491-9485
Practice Address - Street 1:6405 N FEDERAL HWY
Practice Address - Street 2:SUITE 402
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1412
Practice Address - Country:US
Practice Address - Phone:954-771-8888
Practice Address - Fax:954-491-9485
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78022207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG99360Medicare UPIN
FL24560Medicare ID - Type Unspecified