Provider Demographics
NPI:1548797079
Name:MCQUEEN, MORRIS ANGLO
Entity Type:Individual
Prefix:
First Name:MORRIS
Middle Name:ANGLO
Last Name:MCQUEEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3574 WABEEK LAKE DR W
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-1271
Mailing Address - Country:US
Mailing Address - Phone:248-396-8047
Mailing Address - Fax:248-745-1627
Practice Address - Street 1:3574 WABEEK LAKE DR W
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-1271
Practice Address - Country:US
Practice Address - Phone:248-396-8047
Practice Address - Fax:248-745-1627
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-15
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIM756194343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)