Provider Demographics
NPI:1366471013
Name:QUIRAM, POLLY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:POLLY
Middle Name:ANN
Last Name:QUIRAM
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Gender:F
Credentials:MD
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Mailing Address - Street 1:7760 FRANCE AVE S
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5800
Mailing Address - Country:US
Mailing Address - Phone:952-929-1131
Mailing Address - Fax:952-897-1178
Practice Address - Street 1:7760 FRANCE AVE S
Practice Address - Street 2:SUITE 310
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55435-5800
Practice Address - Country:US
Practice Address - Phone:952-929-1131
Practice Address - Fax:952-897-1178
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2007-07-11
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Provider Licenses
StateLicense IDTaxonomies
MI4301085965207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4740432Medicaid
MI4740432Medicaid