Provider Demographics
NPI:1487739827
Name:MINER, MICHAEL H (PHD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:H
Last Name:MINER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3989 CENTRAL AVE NE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-3900
Mailing Address - Country:US
Mailing Address - Phone:612-625-1500
Mailing Address - Fax:
Practice Address - Street 1:1300 S 2ND ST
Practice Address - Street 2:SUITE 180
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1075
Practice Address - Country:US
Practice Address - Phone:612-625-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1169103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN704020200Medicaid
MNHP27165OtherHEALTH PARTNERS
MN1007674OtherPREFERRED ONE
MN61-90177OtherMEDICA CHOICE
MN102454OtherUCARE
MN61-90177OtherMEDICA CHOICE
MN102454OtherUCARE