Provider Demographics
NPI:1194576728
Name:ALQUIST, MICHAEL EUGENE
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EUGENE
Last Name:ALQUIST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4716 N ROBERT RD APT C
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-6175
Mailing Address - Country:US
Mailing Address - Phone:602-600-5355
Mailing Address - Fax:
Practice Address - Street 1:4716 N ROBERT RD APT C
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-6175
Practice Address - Country:US
Practice Address - Phone:602-600-5355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHAD14079237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty