Provider Demographics
NPI:1861584674
Name:MIN, STEVE (DO)
Entity type:Individual
Prefix:
First Name:STEVE
Middle Name:
Last Name:MIN
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 1:3400 N CENTER RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-7920
Mailing Address - Country:US
Mailing Address - Phone:989-753-9000
Mailing Address - Fax:
Practice Address - Street 1:3400 N CENTER RD
Practice Address - Street 2:SUITE 400
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-7920
Practice Address - Country:US
Practice Address - Phone:989-753-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010135742085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4824069Medicaid
MIP00273202OtherRAILROAD MEDICARE
MIG36004068OtherMEDICARE PTAN
WI43513200Medicaid
MI4824069OtherMOLINA HEALTHCARE
MI4824069OtherHEALTHPLAN OF MI
MIH70711Medicare UPIN
MI4824069Medicaid
MIG36004068Medicare PIN