Provider Demographics
NPI:1538422738
Name:MINELLO, CHRISTOPHER MICHAEL (DO)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:MINELLO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5437 E SR 44
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34748-6014
Mailing Address - Country:US
Mailing Address - Phone:352-787-1324
Mailing Address - Fax:352-365-1003
Practice Address - Street 1:5437 E SR 44
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:FL
Practice Address - Zip Code:34748-6014
Practice Address - Country:US
Practice Address - Phone:352-787-1324
Practice Address - Fax:352-365-1003
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS017467207R00000X
FLOS19610207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102988225005Medicaid
NY04625325Medicaid