Provider Demographics
NPI:1295732857
Name:MINIEKA, MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:MINIEKA
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 1:737 N MICHIGAN AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-6662
Mailing Address - Country:US
Mailing Address - Phone:312-337-6960
Mailing Address - Fax:312-337-3601
Practice Address - Street 1:737 N MICHIGAN AVE STE 700
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-6662
Practice Address - Country:US
Practice Address - Phone:312-926-3731
Practice Address - Fax:312-926-3709
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360733982084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E19180Medicare UPIN