Provider Demographics
NPI:1184814303
Name:QUIROGA, MARTIN (DO)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:QUIROGA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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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
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101017430208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery