Provider Demographics
NPI:1508193269
Name:MOSES MUZQUIZ JR, M.D., P.C.
Entity Type:Organization
Organization Name:MOSES MUZQUIZ JR, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MOSES
Authorized Official - Middle Name:
Authorized Official - Last Name:MUZQUIZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:517-787-4111
Mailing Address - Street 1:1041 LAURENCE AVENUE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202
Mailing Address - Country:US
Mailing Address - Phone:517-787-4111
Mailing Address - Fax:517-782-8869
Practice Address - Street 1:1041 LAURENCE AVENUE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202
Practice Address - Country:US
Practice Address - Phone:517-787-4111
Practice Address - Fax:517-782-8869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RC0000X
MI4301026718207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4904OtherGLHP
MI6305OtherHPM
0603883572OtherBLUE CROSS BLUE SHIELD
MI1979265Medicaid
6305OtherHEALTH PLAN OF MICHIGAN
M012105OtherCHAMPUS
MIM012105OtherCHAMPUS
MI0420163OtherPHP
MI0603883572OtherBCBS
MI060010955OtherRR MEDICARE
MI102860OtherPPOM
060010955OtherRAILROAD MEDICARE
4904OtherGREAT LAKES HEALTH PLAN
MIP58363OtherBLUE CARE NETWORK
M012105OtherCHAMPUS