Provider Demographics
NPI:1720032907
Name:QU, ZHENHONG (MD PHD)
Entity Type:Individual
Prefix:
First Name:ZHENHONG
Middle Name:
Last Name:QU
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26901 BEAUMONT BLVD
Mailing Address - Street 2:SUITE 3D
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:947-522-1859
Mailing Address - Fax:947-522-0307
Practice Address - Street 1:3601 W 13 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6712
Practice Address - Country:US
Practice Address - Phone:248-898-9060
Practice Address - Fax:248-898-9054
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-073135-L207ZP0101X
NY243-083-1207ZP0101X
TXL7125207ZP0105X
MI4301095797207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A8415OtherBCBS
TX220031195OtherRAILROAD MEDICARE
TX145124701Medicaid
TX8797M7Medicare ID - Type Unspecified
NYRB2484Medicare PIN
TX220031195OtherRAILROAD MEDICARE