Provider Demographics
NPI:1760130611
Name:MARTIN QUIROGA PC
Entity Type:Organization
Organization Name:MARTIN QUIROGA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:
Authorized Official - Last Name:CULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-676-8000
Mailing Address - Street 1:8152 25 MILE RD STE B
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-1904
Mailing Address - Country:US
Mailing Address - Phone:586-806-6466
Mailing Address - Fax:586-806-6395
Practice Address - Street 1:8152 25 MILE RD STE B
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-1904
Practice Address - Country:US
Practice Address - Phone:586-806-6466
Practice Address - Fax:586-806-6395
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARTIN QUIROGA PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center