Provider Demographics
NPI:1235560988
Name:DIAGNOSTIC EVALUATION SERVICES, PLLC
Entity Type:Organization
Organization Name:DIAGNOSTIC EVALUATION SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:QUTUB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-246-9879
Mailing Address - Street 1:PO BOX 271388
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-0023
Mailing Address - Country:US
Mailing Address - Phone:303-246-9879
Mailing Address - Fax:
Practice Address - Street 1:17401 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-3700
Practice Address - Country:US
Practice Address - Phone:303-246-9879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIE31056261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center