Provider Demographics
NPI:1225015209
Name:QUERTERMUS, JOHN F (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:QUERTERMUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:SUITE 475
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-276-0000
Mailing Address - Fax:269-276-0001
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:M 475
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-276-0000
Practice Address - Fax:269-276-0001
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301031291207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104436943Medicaid
MI1225015209Medicaid
MI1417961137OtherBCBSM - BRONSON
MI0N56500001Medicare ID - Type Unspecified
MIB45148Medicare UPIN
MIC97618327 - BRONSONMedicare PIN