Provider Demographics
NPI:1972536639
Name:MINIGUTTI, ANDREW P (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:P
Last Name:MINIGUTTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4280 MAIN ST
Mailing Address - Street 2:STE 200
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-3080
Mailing Address - Country:US
Mailing Address - Phone:972-464-2510
Mailing Address - Fax:214-705-1379
Practice Address - Street 1:4280 MAIN ST
Practice Address - Street 2:STE 200
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-3075
Practice Address - Country:US
Practice Address - Phone:972-464-2510
Practice Address - Fax:214-705-1379
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL858554952083B0002X
TXL3756207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A0157Medicare ID - Type Unspecified
TX153749002Medicaid
TX8B4053Medicare ID - Type Unspecified
TX153749005Medicaid
TXG54387Medicare UPIN
TX153749003Medicaid
TXTXB106097Medicare PIN
TX153749001Medicaid
TXTXB122598Medicare PIN