Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 003756 | OH |
Y | 213ES0000X | Sports Medicine | 003756 | OH |
NPI | 1346712361 |
---|---|
Provider Name | Andrew Mindeck |
First Address | Mentor On The Lake, OH 44060-9014 |
Second Address | Garfield Heights, OH 44125-5371 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2019 |
Last Update Date | 02/01/2019 |