Provider Demographics
NPI:1528023421
Name:GARZA-QUINTERO, RICARDO (PHD, MD)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:GARZA-QUINTERO
Suffix:
Gender:M
Credentials:PHD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 BURTON ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-4670
Mailing Address - Country:US
Mailing Address - Phone:616-245-1947
Mailing Address - Fax:616-245-7151
Practice Address - Street 1:2000 BURTON ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-4670
Practice Address - Country:US
Practice Address - Phone:616-245-1947
Practice Address - Fax:616-245-7151
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301067451207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI417-8491Medicaid
MI417-8491Medicaid
MIG36157Medicare UPIN