Provider Demographics
NPI:1720124548
Name:MCQUILLEN, MICHAEL PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PAUL
Last Name:MCQUILLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3611 LOUIS RD
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-4408
Mailing Address - Country:US
Mailing Address - Phone:650-858-1601
Mailing Address - Fax:650-725-7459
Practice Address - Street 1:300 PASTEUR DR RM A343
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:650-723-5297
Practice Address - Fax:650-725-7459
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG876752084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G876750Medicaid
CAC66070Medicare UPIN
CA00G876750Medicare PIN