Provider Demographics
NPI:1356370407
Name:AQUINO, PAULINE C (MD)
Entity type:Individual
Prefix:DR
First Name:PAULINE
Middle Name:C
Last Name:AQUINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5092 W VIENNA RD
Mailing Address - Street 2:STE G
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-2803
Mailing Address - Country:US
Mailing Address - Phone:810-686-2212
Mailing Address - Fax:810-686-7940
Practice Address - Street 1:5092 W VIENNA RD
Practice Address - Street 2:STE G
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-2803
Practice Address - Country:US
Practice Address - Phone:810-686-2212
Practice Address - Fax:810-686-7940
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301079584207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0802511112OtherBCBSM INDIVIDUAL PIN
MI4721150Medicaid
MI0802511112OtherBCBSM INDIVIDUAL PIN
MII13849Medicare UPIN