Provider Demographics
NPI:1457563488
Name:SENDELBACH, MARIQUIT DUMAGUIN (DO)
Entity Type:Individual
Prefix:
First Name:MARIQUIT
Middle Name:DUMAGUIN
Last Name:SENDELBACH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23133 ORCHARD LAKE RD
Mailing Address - Street 2:STE 200
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-3268
Mailing Address - Country:US
Mailing Address - Phone:248-579-9220
Mailing Address - Fax:248-426-7350
Practice Address - Street 1:23133 ORCHARD LAKE RD STE 200
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-3268
Practice Address - Country:US
Practice Address - Phone:248-471-8982
Practice Address - Fax:248-471-9978
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015783207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1457563488Medicaid
MI1457563488Medicaid