Provider Demographics
NPI:1386933133
Name:MINNEMAN, SAMANTHA MILNE (MD)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:MILNE
Last Name:MINNEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5575 TECH CENTER DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-2353
Mailing Address - Country:US
Mailing Address - Phone:719-291-2950
Mailing Address - Fax:
Practice Address - Street 1:5575 TECH CENTER DR
Practice Address - Street 2:SUITE 106
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-2353
Practice Address - Country:US
Practice Address - Phone:719-291-2950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0054031208000000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics