Provider Demographics
NPI:1427027077
Name:MICHAEL B MACQUARRIE MD INC
Entity Type:Organization
Organization Name:MICHAEL B MACQUARRIE MD INC
Other - Org Name:NORTH TAHOE EMERGENCY PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:M.D./OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:MACQUARRIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-582-3140
Mailing Address - Street 1:1601 CUMMINS DR STE D
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95358-6411
Mailing Address - Country:US
Mailing Address - Phone:510-350-2666
Mailing Address - Fax:510-879-9061
Practice Address - Street 1:880 ALDER AVE
Practice Address - Street 2:
Practice Address - City:INCLINE VILLAGE
Practice Address - State:NV
Practice Address - Zip Code:89451-8335
Practice Address - Country:US
Practice Address - Phone:530-582-3220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG23578207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0090630Medicaid
NVV35475Medicare ID - Type Unspecified
A42004Medicare UPIN
CAGR0090630Medicaid