Provider Demographics
NPI:1407571433
Name:AQUINO INTEGRATIVE INTERNAL MEDICINE
Entity Type:Organization
Organization Name:AQUINO INTEGRATIVE INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:AQUINO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:313-401-0256
Mailing Address - Street 1:726 WESTCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1826
Mailing Address - Country:US
Mailing Address - Phone:313-929-6407
Mailing Address - Fax:313-672-6241
Practice Address - Street 1:7633 E JEFFERSON AVE STE 170
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-3731
Practice Address - Country:US
Practice Address - Phone:313-401-0256
Practice Address - Fax:313-672-6241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1780671461Medicaid
MIMI4989600OtherOTHER
MIH50533Medicaid