Provider Demographics
NPI:1174849988
Name:MARTIN QUIROGA PC
Entity Type:Organization
Organization Name:MARTIN QUIROGA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:QUIROGA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-806-6466
Mailing Address - Street 1:27101 SCHOENHERR RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-4730
Mailing Address - Country:US
Mailing Address - Phone:586-806-6466
Mailing Address - Fax:586-806-6395
Practice Address - Street 1:27101 SCHOENHERR RD STE 200
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088
Practice Address - Country:US
Practice Address - Phone:586-806-6466
Practice Address - Fax:586-806-6395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-19
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center