Active NPI
Kyle Donald Minaudo, LMT
- Massage Therapist
- Warren, MI
National Provider Identifier
1306414206
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 7501014287
- Practice address
- 2243 E 12 Mile Rd
Warren, MI 48092-5644 - Phone
- (586) 573-8100
- Fax
- (586) 573-8101
- NPI assigned
- Jun 16, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 7501014287 | MI | Primary |
Addresses
Primary practice location
2243 E 12 Mile Rd
Warren, MI 48092-5644
Mailing address
2243 E 12 Mile Rd
Warren, MI 48092-5644
Phone (586) 573-8100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497708200 | Other | TX | MEDICARE |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | ehrsystem | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7501014287 | MI | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1623801600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623801600000",
"number": "1306414206",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2243 E 12 MILE RD",
"city": "WARREN",
"state": "MI",
"postal_code": "480925644",
"telephone_number": "586-573-8100",
"fax_number": "586-573-8101"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2243 E 12 MILE RD",
"city": "WARREN",
"state": "MI",
"postal_code": "480925644",
"telephone_number": "586-573-8100",
"fax_number": "586-573-8101"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MINAUDO",
"first_name": "KYLE",
"middle_name": "DONALD",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-06-16",
"last_updated": "2021-06-16",
"certification_date": "2021-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "MI",
"license": "7501014287",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "1497708200",
"state": "TX"
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "ehrsystem",
"affiliation": "N",
"endpointDescription": "soapnotes",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "warren",
"address_1": "2243 E 12 Mile Rd",
"city": "Warren",
"state": "MI",
"country_code": "US",
"postal_code": "480925644",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Warren, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.