Provider Demographics
NPI:1437729860
Name:MINARDO, GARRET A (PA-C)
Entity type:Individual
Prefix:
First Name:GARRET
Middle Name:A
Last Name:MINARDO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10300 N ILLINOIS ST STE 1100
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46290-1167
Mailing Address - Country:US
Mailing Address - Phone:317-944-0980
Mailing Address - Fax:
Practice Address - Street 1:550 UNIVERSITY BLVD STE 1710
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5149
Practice Address - Country:US
Practice Address - Phone:317-944-0980
Practice Address - Fax:317-968-1221
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
363A00000X
IN10003450A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant