Provider Demographics
NPI:1962664961
Name:MINIX, AMY LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:LYNN
Last Name:MINIX
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 1:3504 BIRCHMORE PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-8475
Mailing Address - Country:US
Mailing Address - Phone:502-418-0461
Mailing Address - Fax:
Practice Address - Street 1:3504 BIRCHMORE PL
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-8475
Practice Address - Country:US
Practice Address - Phone:502-418-0461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY44325207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100136340Medicaid
P400043273Medicare PIN